Black cohosh efficacy and safety for menopausal symptoms. The Spanish Menopause Society statement.

OBJECTIVE: The increasing interest in Western countries regarding phytotherapy use to treat menopause-related symptoms has led the Spanish Menopause Society (AEEM) to update its position statement performed in 2009 on the role of black cohosh (Cimicifuga racemosa) for the treatment of menopausal symptoms. MATERIAL AND METHODS: A panel of experts from both clinical and research backgrounds were assembled to investigate the best available evidence. Selected studies were obtained by an electronic search, including the Internet search engines MEDLINE-Pubmed (1997-December 2021) and the Cochrane Controlled Trials Register. RESULTS: Most of the well-designed studies published in recent years have been conducted with the isopropanolic extract of black cohosh/C. racemosa. The most common dose is 40 mg/day capable of achieving a significant reduction in hot flushes (particularly in women with intense hot flushes) and an improvement in mood. Used at the recommended doses, C. racemose produces no significant adverse reactions. CONCLUSION: Black cohosh is an effective and safe treatment option for the relieving of vasomotor symptoms. Finally, further clinical trials with sufficient patient enrollment and longer study follow-up are needed.

Quantitative Quadrupolar NMR (qQNMR) via nitrogen-14 for the accurate control of L-carnitine in food supplements.

A qQNMR methodology using nitrogen-14 as the quadrupolar nucleus of choice has been introduced for the first time as a robust and validated method to determine and quantify L-carnitine in food supplements. The quantification has been carried out by the alternative use of a calibration curve or by addition of ammonium chloride as internal standard. The method was validated at seven concentration levels in the range of 5.58-99.26 mM, affording intra- and inter day accuracies lower than 6.84% (expressed in CV), robustness towards temperature and recycle delay, limit of detection (LOD) of 2.48 mM, limit of quantification (LOQ) of 5.58 mM and remarkably with absence of matrix effect.

Ab interno implantation of glaucoma drainage devices tubes in the posterior chamber.

BACKGROUND: Glaucoma drainage device (GDD) implantation in the anterior chamber are associated with corneal complications. We describe a novel technique to implant GDD tubes in the posterior chamber of pseudophakic eyes. METHODS: Ten patients with glaucoma who required GDD tube implantation were included. RESULTS: The new technique begins with the passage of one of two straight needles existing at each end of a 10-0 Polypropylene suture through the GDD tube. A 23-gauge needle then is inserted at an angle 180° away and passed from the anterior to the posterior chamber and finally through the sclera. The two suture straight needles from the 10-0 Polypropylene suture are positioned in the lumen of the 23-gauge needle. The 23-gauge needle is then extracted from the eye by passing the 2 needles through the lumen. The suture remains inside the posterior chamber, and the tube is inserted into the posterior chamber by pulling on the suture from the other side. No intra-operative complications were found such as bleeding, vitreous tube placement, bent tubes, etc. CONCLUSIONS: This surgical procedure to implant a tube into the posterior chamber of the pseudophakic eyes is uncomplicated and facilitates the insertion of the flexible tube into the posterior chamber. This eliminates the tendency of the tube to enter the vitreous as the tube is always placed in the posterior chamber away from the cornea. TRIAL REGISTRATION: Current Controlled Trials ISRCTN14276553 (31th May, 2019) Retrospectively registered.

Eficacia, seguridad y satisfacción de los procedimientos de sedoanalgesia en las urgencias españolas / Efficacy, safety and satisfaction of sedation-analgesia in Spanish emergency departments

OBJETIVOS: La sedoanalgesia debe ser una prioridad de los servicios de urgencias pediátricas. Analizamos la eficacia y seguridad de los procedimientos de sedoanalgesia así como la satisfacción del personal, pacientes y padres. MÉTODOS: Estudio multicéntrico, prospectivo, observacional y analítico de los procedimientos de sedoanalgesia realizados a niños hasta los 18 años en 18 servicios de urgencias entre febrero de 2015 y enero de 2016. RESULTADOS: Se registraron 658 procedimientos (edad media: 6,8; DE: 4 años). La eficacia fue buena en 483 niños (76,1%; IC 95%: 72,7-79,4%), parcial en 138 (21,7%; IC 95%: 18,5-24,9%) y mala en 14 (2,2%; IC 95%: 1,1-3,4). Se asoció con eficacias mejores la realización por el pediatra de urgencias (OR: 3,14; IC 95%: 1,10-8,95) y un mayor nivel de sedación alcanzado (OR: 2,37; IC 95%: 1,68-3,35). Presentaron eventos adversos precoces 52 (8,4%) niños, siendo los más frecuentes: digestivos, neurológicos y respiratorios (el 89,9% remitieron en < 2 h). Un paciente requirió intubación. La mayor edad y la mayor profundidad de sedación fueron factores de riesgo independientes para presentar eventos adversos (OR: 1,18; IC 95%: 1,09-1,28 y OR: 1,86; IC 95%: 1,22-2,83, respectivamente). Trece niños (5%) presentaron eventos adversos tardíos, siendo el mareo y las náuseas/vómitos los más frecuentes; en todos ellos se usó la combinación midazolam/ketamina (RR: 24,46; IC95%: 11,78-50,76). Registramos la satisfacción percibida (puntuación de 0-10) de 604 profesionales (media: 8,54, DE: 1,95), de 526 padres (media: 8,86; DE: 1,49) y de 402 niños (media: 8,78; DE: 1,70). CONCLUSIONES: Los procedimientos de sedoanalgesia realizados por profesionales entrenados en los servicios de urgencias pediátricas españoles resultan útiles, eficaces y seguros, además de satisfactorios para todos los participantes

OBJECTIVES: To offer analgesia and sedation should be a priority in paediatric emergency departments. The aim of this study was to determine the effectiveness and safety of the sedation-analgesia procedure, as well as the satisfaction of the doctors, patients and parents. METHODS: A multicentre, observational, and prospective analytical study was conducted on the sedation-analgesia procedure performed on children younger than 18 years old in 18 paediatric emergency departments in Spain from February 2015 until January 2016. RESULTS: A total of 658 procedures were recorded. The effectiveness was good in 483 cases (76.1%; 95% CI: 72.7-79.4%), partial in 138 (21.7%; 95% CI: 18.5-24.9%), and poor in 14 (2.2%; 95%CI: 1.1-3.4). The effectiveness was better when the doctor in charge was an emergency paediatrician (OR: 3.14; 95%C I: 1.10-8.95), and when a deeper level of sedation was achieved (OR: 2.37; 95% CI: 1.68-3.35). Fifty two children (8.4%) developed adverse drug reactions, more usually gastrointestinal, neurological or respiratory ones (89.9% were resolved in < 2 h). One patient was intubated. The older child and a deeper level of sedation were found to be independent risk factors for adverse reactions (OR: 1.18; 95% CI: 1.09-1.28 and OR: 1.86; 95% CI: 1.22-2.83, respectively). Thirteen children (5%) developed late adverse drug reactions, more commonly, dizziness and nauseas. A combination of midazolam/ketamine had been used in all the cases (RR: 24.46; 95% CI: 11.78-50.76). The perceived satisfaction level (0-10) was obtained from 604 doctors (mean: 8.54; SD: 1.95), 526 parents (mean: 8.86; SD: 1.49), and 402 children (mean: 8.78; SD: 1.70). CONCLUSIONS: The sedation-analgesia procedure performed in paediatric emergency departments by trained paediatricians seems to be useful, effective and safe, as well as satisfactory for all participants

[Efficacy, safety and satisfaction of sedation-analgesia in Spanish emergency departments]. / Eficacia, seguridad y satisfacción de los procedimientos de sedoanalgesia en las urgencias españolas.

OBJECTIVES: To offer analgesia and sedation should be a priority in paediatric emergency departments. The aim of this study was to determine the effectiveness and safety of the sedation-analgesia procedure, as well as the satisfaction of the doctors, patients and parents. METHODS: A multicentre, observational, and prospective analytical study was conducted on the sedation-analgesia procedure performed on children younger than 18 years old in 18 paediatric emergency departments in Spain from February 2015 until January 2016. RESULTS: A total of 658 procedures were recorded. The effectiveness was good in 483 cases (76.1%; 95%CI: 72.7-79.4%), partial in 138 (21.7%; 95%CI: 18.5-24.9%), and poor in 14 (2.2%; 95%CI: 1.1-3.4). The effectiveness was better when the doctor in charge was an emergency paediatrician (OR: 3.14; 95%CI: 1.10-8.95), and when a deeper level of sedation was achieved (OR: 2.37; 95%CI: 1.68-3.35). Fifty two children (8.4%) developed adverse drug reactions, more usually gastrointestinal, neurological or respiratory ones (89.9% were resolved in <2h). One patient was intubated. The older child and a deeper level of sedation were found to be independent risk factors for adverse reactions (OR: 1.18; 95%CI: 1.09-1.28 and OR: 1.86; 95%CI: 1.22-2.83, respectively). Thirteen children (5%) developed late adverse drug reactions, more commonly, dizziness and nauseas. A combination of midazolam/ketamine had been used in all the cases (RR: 24.46; 95%CI: 11.78-50.76). The perceived satisfaction level (0-10) was obtained from 604 doctors (mean: 8.54; SD: 1.95), 526 parents (mean: 8.86; SD: 1.49), and 402 children (mean: 8.78; SD: 1.70). CONCLUSIONS: The sedation-analgesia procedure performed in paediatric emergency departments by trained paediatricians seems to be useful, effective and safe, as well as satisfactory for all participants.

Assessment of proadrenomedullin as diagnostic or prognostic biomarker of acute appendicitis in children with acute abdominal pain.

BACKGROUND: Acute appendicitis (AA) is one of the most frequent surgical pathologies in pediatrics. OBJECTIVES: To investigate the utility of proadrenomedullin (pro-ADM) for the diagnosis of AA. METHODS: Prospective, analytical, observational, and multicenter study conducted in 6 pediatric emergency departments. Children up to 18 years of age with suspected AA were included. Clinical, epidemiological, and analytical data were collected. RESULTS: We studied 285 children with an average age of 9.5 years (95% confidence interval [CI], 9.1-9.9). AA was diagnosed in 103 children (36.1%), with complications in 10 of them (9.7%). The mean concentration of pro-ADM (nmol/L) was higher in children with AA (0.51 nmol/L, SD 0.16) than in children with acute abdominal pain (AAP) of another etiology (0.44 nmol/L, SD 0.14; p < 0.001). This difference was greater in complicated cases compared with uncomplicated AA (0.64 nmol/L, SD 0.17 and 0.50 nmol/L, SD 0.15, respectively; p = 0.005). The areas under the receiver-operating characteristic curves were 0.66 (95% CI, 0.59-0.72) for pro-ADM, 0.70 (95% CI, 0.63-0.76) for C-reactive protein (CRP), 0.84 (95% CI, 0.79-0.89) for neutrophils, and 0.84 (95% CI, 0.79-0.89) for total leukocytes. The most reliable combination to rule out AA was CRP ≤1.25 mg/dL and pro-ADM ≤0.35 nmol/L with a sensitivity of 96% and a negative predictive value of 93%. CONCLUSION: Children with AA presented higher pro-ADM values than children with AAP of other etiologies, especially in cases of complicated AA. The combination of low values of pro-ADM and CRP can help to select children with low risk of AA.

Prevalence of sarcopenia and associated factors in institutionalised older adult patients.

BACKGROUND & AIMS: Sarcopenia is a syndrome characterised by a progressive and generalised loss of skeletal muscle mass and strength with a risk of adverse outcomes such as physical disability, poor quality of life and death. The main aim of the present study was to establish the prevalence of sarcopenia using EWGSOP-defined criteria in institutionalised older adult patients in long-term care institutions. A secondary purpose was to identify the risk factors that develop Sarcopenia in this population. METHODS: A Multicentre cross-sectional study was conducted in 334 institutionalised older adult patients, where the prevalence of sarcopenia and its relation with certain risk factors were measured. Physical performance was measured by gait speed, muscle strength measured by a handheld dynamometer and skeletal muscle mass measured using bioimpedance analysis. Different variables were collected: body mass index (BMI), diseases documented in the clinical record, the numbers of falls, the level of activity and functional ability. RESULTS: Two hundred eighty five individuals were included. According the EWGSOP algorithm and the cut-off points proposed by Masanes et al. for the Spanish population, 118 (41.4%) participants presented sarcopenia, of which 32 patients (27%) suffered from moderate sarcopenia, 78 patients (66%) were identified as severe sarcopenia patients and only 8 (7%) were classified as sarcopenic obesity. More female residents (96 females (81.4%) vs. 22 males (18.6%), p < 0.0001) tended to be sarcopenic. Patients diagnosed with sarcopenia tended to be more functionally impaired and had a more unfavourable BMI than those who were not sarcopenic (Barthel score 40.93 vs, 49.22, p = 0.0034 and BMI 23.57 vs, 27.61, p < 0.0001). Results from regression analysis indicated that those older than 85 years old (OR 2.495, 95% CI 1.401-4.441), the female gender, (OR 3.215, 95%CI 1.635-6.324) and whose BMI was lower than 22 (OR 5.973, 95% CI 2.932-12.165) appeared to be associated with sarcopenia, whereas the Barthel Index and other factors were not. CONCLUSION: The present study suggests that sarcopenia is highly prevalent in patients living in long-term care institutions, especially in female patients. Our findings support that the muscle mass was negatively associated with poor nutritional status and poor capacity to develop basic activities of daily living that indicates high dependency of these patients and high necessity of care.

Preparación de los procedimientos de sedoanalgesia en los servicios de urgencias pediátricos españoles: estudio descriptivo / Preparation of sedation-analgesia procedures in spanish paediatric emergency departments: A descriptive study

INTRODUCCIÓN: El objetivo de este estudio fue describir la práctica clínica actual de la preparación de los procedimientos de sedoanalgesia (SA) realizados en servicios de urgencias pediátricas (SUP) españoles. MATERIAL Y MÉTODOS: Estudio multicéntrico, observacional y analítico prospectivo de los procedimientos de SA realizados a niños menores de 18 años en 18 SUP entre febrero del 2015 y enero del 2016. RESULTADOS: Se registraron 658 procedimientos de SA en 18 hospitales de España, la mayoría (90,7%) en mayores de 24 meses. El tipo de procedimiento fue: 57 (8,6%) analgesia simple, 44 (6,7%) sedación, 275 (41,8%) SA para procedimiento poco doloroso y 282 (42,9%) SA para procedimiento muy doloroso. Se solicitó consentimiento informado al 98,6%, siendo más frecuentemente escrito en el grupo de SA para procedimientos muy dolorosos (76,6%) que en procedimientos poco dolorosos o en analgesia simple (el 62,9 y el 54,4%, respectivamente, p < 0,001). El personal que más frecuentemente realizó la SA fueron los pediatras de urgencias (64,3%), seguidos de los residentes de pediatría (30,7%). Los motivos de la SA más frecuentes fueron los traumatológicos (35,9%) y quirúrgicos (28,4%). El ayuno se valoró en el 81%. Se monitorizaron 480 (73%) niños, la mayoría de ellos con pulsioxímetro (95,8%). La estrategia farmacológica utilizada fue la administración de un fármaco de forma aislada en 443 (67,3%) de los casos, siendo más frecuente el óxido nitroso (50%) y una combinación de fármacos en 215 (32,7%), destacando la combinación midazolam/ketamina (46,9%). CONCLUSIÓN: La mayoría de los procedimientos de SA analizados en este estudio han tenido una preparación correcta y acorde a las recomendaciones actuales

INTRODUCTION: The objective of this study was to describe the current practice regarding the preparation of the sedation-analgesia (SA) procedures performed in the paediatric emergency centres in Spain. MATERIAL AND METHODS: A multicentre, observational and prospective analytical study was carried out on the SA procedures that were performed on children under 18 years-old in 18 paediatric emergency departments between February 2015 and January 2016. RESULTS: A total of 658 SA procedures were registered in 18 hospitals of Spain, most of them to children older than 24 months. The type of the procedure was: simple analgesia in 57 (8.6%), sedation in 44 (6.7%), SA for a not very painful procedure in 275 (41.8%), and SA for a very painful procedure in 282 (42.9%). Informed consent was requested in 98.6% of the cases. The written form was more frequently preferred in the group of patients that received SA for a very painful procedure (76.6%) in comparison to a painful procedure or to simple analgesia (62.9% and 54.4%, respectively, P < .001). The staff that most frequently performed the SA procedures were the paediatricians of the emergency departments (64.3%), followed by Paediatrics Residents (30.7%). The most frequent reasons for the SA were traumatological (35.9%) and surgical (28.4%). Fasting was observed in 81% of the cases. More than two-thirds (67.3%, n = 480) children were monitored, the majority (95.8%) of them using pulse oximetry. The pharmacological strategy used was the administration of one drug in 443 (67.3%) of the cases, mostly nitrous oxide, and a combination of drugs in 215 (32.7%), especially midazolam/ketamine (46.9%). CONCLUSION: The majority of the SA procedures analysed in this study have been carried out correctly and prepared in accordance with the current guidelines

The Knowledge of and Attitudes Toward First Aid and Cardiopulmonary Resuscitation Among Parents.

PURPOSE: To determine the level of knowledge of first aid and cardiopulmonary resuscitation (CPR) among the parents of children who attended our Pediatric Emergency Department and to identify the factors that affect this knowledge. DESIGN AND METHODS: Descriptive, transversal study. A questionnaire was distributed anonymously among parents to collect data about their previous CPR training, knowledge and experience. RESULTS: A total 405 valid questionnaires were returned. The mean age of the sample was 38.08 (SD 7.1) years, and 66.9% of participants were female. The mean score of correctly answered questions was 6.76 out of 19 questions. Parents with a university education received a mean score of 7.16 versus 6.24 for those with a primary education (p = 0.022). Parents with previous training received a higher mean score (8.04 vs 6.17, respectively, p < 0.01). Parents with jobs related to healthcare or education received a higher mean score compared to those who did not (8.63, p < 0.01 and 7.16, p = 0.0013, respectively). No significant differences among parents with chronically ill children (p = 0.76) or related to the number of children (ρ = -0.101) were observed. Furthermore, 77.3% of parents expressed an interest in receiving further training. CONCLUSIONS: Knowledge of first aid among the general population is lacking. Parents with previous training in this field, those with a university-level education, and those who are healthcare providers and educational professionals received significantly higher scores. PRACTIC IMPLICATIONS: Studies based on surveys can be useful in estimating a population's knowledge base, allowing the development of community-based training activities.

Hemangioma mamario en una lactante con aparente mastitis: Caso clínico / Mammary hemangioma in an infant with apparent mastitis: Case report

La patología mamaria en pediatría es infrecuente. El hallazgo de una masa a nivel mamario en un lactante es una situación poco común. Los posibles diagnósticos a esta edad son absceso mamario, mastitis, ingurgitación mamaria por estimulación hormonal materna y hemangioma. Es importante llegar al diagnóstico adecuado para emplear un tratamiento acorde y evitar la aparición de complicaciones de dichas patologías. Se presenta un caso de una lactante con una masa en la mama derecha detectada desde el nacimiento. Inicialmente, se trató como una mastitis, pero dada la mala evolución, se plantearon diagnósticos diferenciales y se concluyó que se trataba de un hemangioma. Debido a la ulceración de la lesión, junto con el riesgo existente de desarrollar hipoplasia mamaria, se decidió iniciar tratamiento con propanolol, con resolución casi completa de la tumoración.

Mammary pathology is infrequent during childhood. It is rare the probability of finding a breast mass in an infant. The most frequent possible diagnoses at this age are breast abscess, mastitis, breast engorgement due to maternal hormonal stimulation and hemangioma. Reaching the proper diagnosis is essential in order to apply a suitable treatment and avoid the potential disease complications. We present the case of a female infant having a mass in the right breast from birth. Initially the entity was treated as mastitis. Nevertheless, the bad evolution made necessary considering the differential diagnosis. It was concluded to be a hemangioma. Due to the lesion ulceration and the potential risk of developing breast hypoplasia, treatment with propranolol was started. The tumor was almost completely resolved.

Evaluación del manejo del dolor de la patología facial y oral en un Servicio de Urgencias Pediátrico y tras el alta domiciliaria / Assessment of orofacial pain management in a pediatric emergency department and at home after discharge

Introducción. El manejo inadecuado del dolor es frecuente en Urgencias. El objetivo fue analizar el manejo del dolor de niños con patología infecciosa o traumática del área facial/oral en Urgencias y evaluar el cumplimiento y satisfacción sobre la analgesia prescrita al momento del alta. Población y métodos. Estudio transversal, observacional y analítico en niños que acudieron a Urgencias con patología infecciosa/traumática de la región facial/oral durante 2 meses. Se recogieron el manejo del dolor en Urgencias, la analgesia prescrita para el domicilio y, tras el contacto telefónico con los padres, el tratamiento realizado y su adecuación al dolor del niño. Resultados. Fueron incluidos 252 pacientes (edad media de 4,5 años, desvío estándar 3,89). En 8,7%, figuraba la evaluación del dolor en triaje y, en 3,6%, en el informe médico. Se administró analgesia en Urgencias al 41,3%. Al momento del alta, en un 13,9%, no se prescribió analgesia; en 25,4%, se prescribió pautada y, en 60,3%, a demanda. Los pediatras usaron más analgesia pautada que los cirujanos (34,4% vs. 16,5%, p < 0,01). En el domicilio, no administraron analgesia en el 39,3%; en un 36,1%, pautada y, en un 23%, a demanda. Existió escasa correlación entre la pauta al momento del alta y la administrada en el domicilio (kappa: 0,178). Se consideró la analgesia adecuada en el 84%, con más frecuencia en patología traumática que infecciosa (85,7% vs. 14,3%, p < 0,01). Conclusiones. Se observó escasa evaluación y tratamiento del dolor en Urgencias. La prescripción más usada fue a demanda en vez de pautada, al contrario de lo recomendado en las guías. El control analgésico fue mejor en patología traumática que infecciosa.

Introduction. An inadequate pain management is common in the emergency department. Our objective was to analyze pain management among children with an orofacial infection or trauma in the emergency department and to assess compliance and satisfaction with analgesia prescribed at discharge. Population and methods. Cross-sectional, observational and analytical study in children attending the emergency department for an orofacial infection or trauma over 2 months. Pain management in the emergency department, analgesia prescribed at home and, following a call to parents, treatment provided and its adequacy to control pain were registered. Results. In total, 252patients (mean age: 4.5 years, SD: 3.89) were included. Pain assessment was recorded at the triage for 8.7%, and in the medical report, for 3.6%. Analgesia was administered to 41.3% in the emergency room. At discharge, no analgesia was prescribed to 13.9%; scheduled analgesia, to 25.4%; and as needed, to 60.3%. Pediatricians prescribed scheduled analgesia more frequently than surgeons (34.4% versus 16.5%, p < 0.01). At home, no analgesia was administered to 39.3%; scheduled analgesia, to 36.1%; and as needed, to 23%. There is little correlation between prescription at discharge and at home (Kappa: 0.178). Analgesia was considered adequate in 84% of cases, and was more frequent in trauma injuries than in infections (85.7% versus 14.3%, p < 0.01). Conclusions. Pain assessment and management was scarce in the emergency department. The most common prescription was as needed, contrary to what is recommended in the guidelines. Analgesic control worked better for trauma injuries than for infections.

Assessment of orofacial pain management in a pediatric emergency department and at home after discharge. / Evaluación del manejo del dolor de la patología facial y oral en un Servicio de Urgencias Pediátrico y tras el alta domiciliaria.

INTRODUCTION: An inadequate pain management is common in the emergency department. Our objective was to analyze pain management among children with an orofacial infection or trauma in the emergency department and to assess compliance and satisfaction with analgesia prescribed at discharge. POPULATION AND METHODS: Cross-sectional, observational and analytical study in children attending the emergency department for an orofacial infection or trauma over 2 months. Pain management in the emergency department, analgesia prescribed at home and, following a call to parents, treatment provided and its adequacy to control pain were registered. RESULTS: In total, 252patients (mean age: 4.5 years, SD: 3.89) were included. Pain assessment was recorded at the triage for 8.7%, and in the medical report, for 3.6%. Analgesia was administered to 41.3% in the emergency room. At discharge, no analgesia was prescribed to 13.9%; scheduled analgesia, to 25.4%; and as needed, to 60.3%. Pediatricians prescribed scheduled analgesia more frequently than surgeons (34.4% versus 16.5%, p < 0.01). At home, no analgesia was administered to 39.3%; scheduled analgesia, to 36.1%; and as needed, to 23%. There is little correlation between prescription at discharge and at home (Kappa: 0.178). Analgesia was considered adequate in 84% of cases, and was more frequent in trauma injuries than in infections (85.7% versus 14.3%, p < 0.01). CONCLUSIONS: Pain assessment and management was scarce in the emergency department. The most common prescription was as needed, contrary to what is recommended in the guidelines. Analgesic control worked better for trauma injuries than for infections.

INTRODUCCIÓN: El manejo inadecuado del dolor es frecuente en Urgencias. El objetivo fue analizar el manejo del dolor de niños con patología infecciosa o traumática del área facial/oral en Urgencias y evaluar el cumplimiento y satisfacción sobre la analgesia prescrita al momento del alta. POBLACIÓN Y MÉTODOS: Estudio transversal, observacional y analítico en niños que acudieron a Urgencias con patología infecciosa/traumática de la región facial/oral durante 2 meses. Se recogieron el manejo del dolor en Urgencias, la analgesia prescrita para el domicilio y, tras el contacto telefónico con los padres, el tratamiento realizado y su adecuación al dolor del niño. RESULTADOS: Fueron incluidos 252 pacientes (edad media de 4,5 años, desvío estándar 3,89). En 8,7%, figuraba la evaluación del dolor en triaje y, en 3,6%, en el informe médico. Se administró analgesia en Urgencias al 41,3%. Al momento del alta, en un 13,9%, no se prescribió analgesia; en 25,4%, se prescribió pautada y, en 60,3%, a demanda. Los pediatras usaron más analgesia pautada que los cirujanos (34,4% vs. 16,5%, p < 0,01). En el domicilio, no administraron analgesia en el 39,3%; en un 36,1%, pautada y, en un 23%, a demanda. Existió escasa correlación entre la pauta al momento del alta y la administrada en el domicilio (kappa: 0,178). Se consideró la analgesia adecuada en el 84%, con más frecuencia en patología traumática que infecciosa (85,7% vs. 14,3%, p < 0,01). CONCLUSIONES: Se observó escasa evaluación y tratamiento del dolor en Urgencias. La prescripción más usada fue a demanda en vez de pautada, al contrario de lo recomendado en las guías. El control analgésico fue mejor en patología traumática que infecciosa.

[Mammary hemangioma in an infant with apparent mastitis. Case report]. / Hemangioma mamario en una lactante con aparente mastitis. Caso clínico.

Mammary pathology is infrequent during childhood. It is rare the probability of finding a breast mass in an infant. The most frequent possible diagnoses at this age are breast abscess, mastitis, breast engorgement due to maternal hormonal stimulation and hemangioma. Reaching the proper diagnosis is essential in order to apply a suitable treatment and avoid the potential disease complications. We present the case of a female infant having a mass in the right breast from birth. Initially the entity was treated as mastitis. Nevertheless, the bad evolution made necessary considering the differential diagnosis. It was concluded to be a hemangioma. Due to the lesion ulceration and the potential risk of developing breast hypoplasia, treatment with propranolol was started. The tumor was almost completely resolved.

La patología mamaria en pediatría es infrecuente. El hallazgo de una masa a nivel mamario en un lactante es una situación poco común. Los posibles diagnósticos a esta edad son absceso mamario, mastitis, ingurgitación mamaria por estimulación hormonal materna y hemangioma. Es importante llegar al diagnóstico adecuado para emplear un tratamiento acorde y evitar la aparición de complicaciones de dichas patologías. Se presenta un caso de una lactante con una masa en la mama derecha detectada desde el nacimiento. Inicialmente, se trató como una mastitis, pero dada la mala evolución, se plantearon diagnósticos diferenciales y se concluyó que se trataba de un hemangioma. Debido a la ulceración de la lesión, junto con el riesgo existente de desarrollar hipoplasia mamaria, se decidió iniciar tratamiento con propanolol, con resolución casi completa de la tumoración.

[Preparation of sedation-analgesia procedures in spanish paediatric emergency departments: A descriptive study]. / Preparación de los procedimientos de sedoanalgesia en los servicios de urgencias pediátricos españoles: estudio descriptivo.

INTRODUCTION: The objective of this study was to describe the current practice regarding the preparation of the sedation-analgesia (SA) procedures performed in the paediatric emergency centres in Spain. MATERIAL AND METHODS: A multicentre, observational and prospective analytical study was carried out on the SA procedures that were performed on children under 18 years-old in 18 paediatric emergency departments between February 2015 and January 2016. RESULTS: A total of 658 SA procedures were registered in 18 hospitals of Spain, most of them to children older than 24 months. The type of the procedure was: simple analgesia in 57 (8.6%), sedation in 44 (6.7%), SA for a not very painful procedure in 275 (41.8%), and SA for a very painful procedure in 282 (42.9%). Informed consent was requested in 98.6% of the cases. The written form was more frequently preferred in the group of patients that received SA for a very painful procedure (76.6%) in comparison to a painful procedure or to simple analgesia (62.9% and 54.4%, respectively, P<.001). The staff that most frequently performed the SA procedures were the paediatricians of the emergency departments (64.3%), followed by Paediatrics Residents (30.7%). The most frequent reasons for the SA were traumatological (35.9%) and surgical (28.4%). Fasting was observed in 81% of the cases. More than two-thirds (67.3%, n=480) children were monitored, the majority (95.8%) of them using pulse oximetry. The pharmacological strategy used was the administration of one drug in 443 (67.3%) of the cases, mostly nitrous oxide, and a combination of drugs in 215 (32.7%), especially midazolam/ketamine (46.9%). CONCLUSION: The majority of the SA procedures analysed in this study have been carried out correctly and prepared in accordance with the current guidelines.

Evaluation and Impact of the "Advanced Pediatric Life Support" Course in the Care of Pediatric Emergencies in Spain.

INTRODUCTION: The Advanced Pediatric Life Support (APLS) course was introduced in the training of professionals who care for pediatric emergencies in Spain in 2005. OBJECTIVE: To analyze the impact of the APLS course in the current clinical practice in Spanish PEDs. METHODS: The directors of APLS courses were asked about information regarding the courses given to date, especially on the results of the satisfaction survey completed by students at the end of the course. Furthermore, in December 2014, a survey was conducted through Google Drive, specifically asking APLS students about the usefulness of the APLS course in their current clinical practice. RESULTS: In the last 10 years since the APLS course was introduced in Spain, there have been 40 courses in 6 different venues. They involved a total of 1520 students, of whom 958 (63.0%) felt that the course was very useful for daily clinical practice. The survey was sent to 1,200 students and answered by 402 (33.5%). The respondent group most represented was pediatricians, 223 (55.5%), of whom 61 (27.3%) were pediatric emergency physicians, followed by pediatric residents, 122 (30.3%). One hundred three (25.6%) respondents had more than 10 years of professional practice and 291 (72.4%) had completed the course in the preceding four years. Three hundred forty-one of the respondents (84.9%: 95% confidence interval [CI], 81.9-87.9) said that they always use the pediatric assessment triangle (PAT) and 131 (32.6%: 95% CI, 28-37.1) reported that their organization has introduced this tool into their protocols. Two hundred twenty-three (55.5%: 95% CI, 50.6-60.3) believed that management of critically ill patients has improved, 328 (81.6%: 95% CI, 77.8-85.3) said that the PAT and the systematic approach, ABCDE, help to establish a diagnosis, and 315 (78.4%: 95% CI, 74.3-82.4) reported that the overall number of treatments has increased but that these treatments are beneficial for patients. Hospital professionals (191; 47.5%) include the PAT in their protocols more frequently than pre-hospital professionals (68.5% vs 55.4%; p <0.01) and consider PAT useful in the management of patients (60.2% vs 51.1%; p <0.05). Neither the time elapsed since the completion of the course, nor category and years of professional experience had any influence on the views expressed about the impact of the APLS course in clinical practice. CONCLUSIONS: Most health professionals who have received the APLS course, especially those working in the hospital setting, think that the application of the systematic methods learned, the PAT and ABCDE, has a major impact on clinical practice.

Conocimiento de las enfermeras de las dosis de medicamentos en urgencias de pediatría / Knowledge of nurses about medication doses at pediatric urgency departament

Los fallos relacionados con la medicación son la segunda causa de errores en pacientes hospitalizados. Los niños son un grupo de riesgo, siendo la presión asistencial del servicio de urgencias determinante en la incidencia de errores. OBJETIVO: Determinar los conocimientos de las enfermeras sobre las dosis de los medicamentos más utilizados en urgencias pediátricas. Material y MÉTODO: Estudio descriptivo transversal realizado a enfermeras de urgencias pediátricas en 14 hospitales de Madrid. Mediante un cuestionario autoadministrado se recogieron datos durante 5 días en enero de 2014: demográficos; del conocimiento en la responsabilidad del personal de enfermería en la administración y en la dosificación de estos medicamentos. Se realizó un análisis descriptivo global y estratificado por tipo de hospital y experiencia laboral. RESULTADOS: La tasa de respuesta fue de 114 (34,9%). Del personal, 80 (70,8%) comprueban las dosis antes de administrarlas; 20 (18,6%) no creen que sea responsabilidad suya administrar una dosis mal prescrita. Hay mayor conocimiento entre el grupo con experiencia mayor a 5 años, excepto en sedoanalgesia (p < 0,05). La media de puntuación obtenida fue de 3,8 sobre 10 (1,99). CONCLUSIONES: El conocimiento de dosis de medicamentos de las enfermeras es deficiente

Errors in drug administration are the second cause of errors in hospitalized PATIENTS: Children are a high risk group. Besides, pressure in care interventions at emergency department leads to increase incidence errors. AIM: Determining nurses' knowledge about the most common drug doses at pediatric urgency department. METHODS: Descriptive transversal study. We collected data from nurses of 14 pediatric emergency departments of Madrid. With an 'ad hoc' questionnaire we collected the following data during five days in January of 2014: demographic, knowledge of responsibility in administration and doses of drugs. Global descriptive analysis was made and it was stratified by hospital and work experience. RESULTS: The answer rate was 114 (34.9%). Only 80 (70.8%) of nurses confirm doses before their administration; 20 (18.6%) think that a wrong prescription that they administer is not their responsibility. There is a high knowledge in the group with more than five years of work experience, except for sedative-analgesic drugs (p < 0.05). The average score obtained was 3.8 of 10 (1.99). CONCLUSIONS: Nurses' knowledge about drug doses is low

[Knowledge of nurses about medication doses at pediatric urgency departament]. / Conocimiento de las enfermeras de las dosis de medicamentos en urgencias de pediatría.

UNLABELLED: Errors in drug administration are the second cause of errors in hospitalized patients. Children are a high risk group. Besides, pressure in care interventions at emergency department leads to increase incidence errors. AIM: Determining nurses' knowledge about the most common drug doses at pediatric urgency department. METHODS: Descriptive transversal study. We collected data from nurses of 14 pediatric emergency departments of Madrid. With an "ad hoc" questionnaire we collected the following data during five days in January of 2014: demographic, knowledge of responsibility in administration and doses of drugs. Global descriptive analysis was made and it was stratified by hospital and work experience. RESULTS: The answer rate was 114 (34.9%). Only 80 (70.8%) of nurses confirm doses before their administration; 20 (18.6%) think that a wrong prescription that they administer is not their responsibility. There is a high knowledge in the group with more than five years of work experience, except for sedative-analgesic drugs (p<0.05). The average score obtained was 3.8 of 10 (1.99). CONCLUSIONS: Nurses' knowledge about drug doses is low.

Grado de efecto de las variables sociodemográficas, laborales, organizativas y del entorno en la duración de la incapacidad temporal por contingencias comunes en España / Effect of the sociodemographic, occupational, organisational and environmental variables on the duration of temporary sick leave in Spain

OBJETIVO: Analizar la relación de distintas variables asociadas con la duración de la incapacidad temporal por contingencia común (ITCC) y determinar su grado de efecto. DISEÑO: Retrospectivo, descriptivo. Emplazamiento: España. PARTICIPANTES: 598.988 procesos de ITCC del total de trabajadores del Régimen General protegidos en una Mutua de Accidentes de Trabajo y Enfermedades Profesionales durante el periodo de 2005 a 2010. MEDICIONES PRINCIPALES: Se analizó la asociación entre las características demográficas, laborales, organizativas y del entorno y la duración mediana de la ITCC, indicando los valores p de cada prueba, y se estimó el índice del tamaño del efecto (d) para comprobar la relevancia de dicha relación, empleando el coeficiente de correlación de pearson (rxy), eta cuadrado (2) y V de Cramer (V). RESULTADOS: La duración mediana de la ITCC fue de 32 días. Se constatan relaciones significativas con la edad, género, nacionalidad, antigüedad en la empresa; salario, tipo de contrato; sector, actividad, y tamaño empresa y región. Así, se encuentra una mayor duración de las bajas en los trabajadores de grandes empresas, mujeres, con nacionalidad española y que trabajan en actividades agrarias, sanitarias, administración y hostelería. La edad además ejerce un efecto considerable (rxy = 0,134) en la duración de las bajas, sobre todo a partir de 44 años. CONCLUSIONES: Tan solo la edad mostró evidencias de un efecto considerable sobre la duración de la ITCC, aun cuando también se relacionó con el resto de características demográficas, laborales, organizativas y del entorno. Además se evidenció la existencia de efectos cruzados entre variables que pueden provocar ocasionalmente errores en la interpretación de los resultados

OBJECTIVES: This study examines the relationship, and relevance of the effect between the duration of the cases of temporary sick leave, as an indicator of absenteeism, and several characteristics (sociodemographic, labor, organizational and the environment) of workers covered by the Social Security System in Spain. Method: A retrospective analysis was conducted on 598,988 processes, between 15 and 365 days. The relationships between length of absence, and several characteristics such as demographic, sociodemographic, occupational, organizational and environment characteristicswere determined (using P values). The mean duration for each of the features is described, and the size effect is calculated to estimate the importance of the relationships found. RESULTS: There were significant relationships between the duration of temporary sick leave and several demographic characteristics (gender, age, nationality and length of service), occupational (wages, type of contract), organizational (economic sector, activity and size company), the environmental (region, state) characteristics. The age also showed a significant size effect (rxy = .134), especially after age 44. CONCLUSIONS: Only age had a significance effect on the duration of work absence, although there was also a relationship with the rest of the demographic, occupational and work environment characteristics. There was also evidence of a cross-effects between the variables, which could cause errors in interpreting the results

[Effect of the sociodemographic, occupational, organisational and environmental variables on the duration of temporary sick leave in Spain]. / Grado de efecto de las variables sociodemográficas, laborales, organizativas y del entorno en la duración de la incapacidad temporal por contingencias comunes en España.

OBJECTIVES: This study examines the relationship, and relevance of the effect between the duration of the cases of temporary sick leave, as an indicator of absenteeism, and several characteristics (sociodemographic, labor, organizational and the environment) of workers covered by the Social Security System in Spain. METHOD: A retrospective analysis was conducted on 598,988 processes, between 15 and 365days. The relationships between length of absence, and several characteristics such as demographic, sociodemographic, occupational, organizational and environment characteristics were determined (using P values). The mean duration for each of the features is described, and the size effect is calculated to estimate the importance of the relationships found. RESULTS: There were significant relationships between the duration of temporary sick leave and several demographic characteristics (gender, age, nationality and length of service), occupational (wages, type of contract), organizational (economic sector, activity and size company), the environmental (region, state) characteristics. The age also showed a significant size effect (rxy=.134), especially after age 44. CONCLUSIONS: Only age had a significance effect on the duration of work absence, although there was also a relationship with the rest of the demographic, occupational and work environment characteristics. There was also evidence of a cross-effects between the variables, which could cause errors in interpreting the results.

Sondaje naso/orogástrico en el paciente pediátrico. Revisión de métodos de comprobación de la ubicación / Naso-orogastric tube in paediatric patients. Review of methods of confirmation of placement

La colocación de la sonda gástrica (SG) es un procedimiento no infrecuente en la población pediátrica. Las SG se utilizan con asiduidad en los servicios de Hospitalización, de Urgencias Pediátricas y en los de Cuidados Críticos. Sus objetivos son diagnósticos, terapéuticos y la descompresión y evacuación del contenido aspirado. La colocación a ciegas de la SG conlleva tasas de colocación incorrecta de entre un 4.7 % y un 69 % de los casos. Se necesita por lo tanto la utilización de un método fiable de determinación de la colocación de la misma. La radiografía (Rx) de tórax es el único método fiable al cien por cien (gold standard), pero solo confirma la colocación en el momento exacto de realización de la Rx. Los métodos no radiológicos son una alternativa fiable que contribuyen a reducir la exposición a radiaciones en los pacientes pediátricos. Hay diversos métodos alternativos a la Rx para verificar la colocación apropiada de la SG y que están respaldados por distintos grados de evidencia científica. Algunos son: medida de la sonda desde el punto de entrada; auscultación, aspiración del contenido estomacal o intestinal para inspeccionarlo visualmente; medición del pH; capnografía, o la combinación de varios de estos métodos. En este artículo se revisa a fondo la validez y la seguridad de algunos de estos métodos no radiológicos como métodos de comprobación de la ubicación de la SG (AU)

Nasogastric tube (NGT) placement is a frequent procedure in the paediatric population. Nasogastric and orogastric tubes are commonly used in hospitalized children, in the paediatric emergency departments and in critical care departments. They have diagnostic, therapeutic, descompression or evacuation of gastric aspirates objectives. Making a blind placement of nasogastric tubes, involve that nasogastric tube could be misplaced in 4.7 % to 69 % of cases. An accurate method for confirmation of nasogastric tube positioning is therefore needed. Chest X-ray remains the only hundred per cent reliable method (gold standard), but it only confirms tube positioning at the exact time of the X-ray. Non-radiologic verification methods provide an accurate alternative and contribute to decrease radiation exposure for pediatric patients. Non-radiologic methods to verify appropiate placement of tubes are many and are supported by different degrees of evidence in the literature: measurement of tube length from point of entry; auscultation; placing the tube in water to assess bubbling; aspiration of stomach or intestinal contents for visual inspection; pH testing; use of CO2 monitoring devices, or combinations of these methods. In this article we thoroughly review the reliability and safety of these non radiologic methods for the verification of nasogastric tube placement (AU)