Equipo multidisciplinar de cirugía radioguiada: Alternativa de cambio al paradigma actual / Multidisciplinary radio-guided surgery team: Alternative to change the current paradigm

IntroducciónAnte el aumento constante de la demanda asistencial de exploraciones relacionadas con cirugía radioguiada (CRG), nuestro hospital adoptó incluir en el equipo de CRG nuevos perfiles profesionales con el fin de reducir parcialmente el tiempo de dedicación de los médicos nucleares a esta tarea.Objetivos: Analizar el proceso de incorporación de los perfiles de Técnico Superior en Imagen para el Diagnóstico (TSID) y Enfermera Referente de Ganglio Centinela (ERGC), evaluando su despliegue en los procedimientos ligados a la técnica. Material y métodos: Análisis de la actividad de CRG durante el periodo 2018-2022, centrándolo en los procedimientos prequirúrgicos y quirúrgicos relativos a cáncer de mama (CaM) y melanoma maligno (MM), por ser aquellas patologías en las que se concentró la transferencia de competencias asistenciales. Evolución cronológica de las competencias asumidas por los diferentes perfiles durante su integración en el equipo de CRG. Resultados: La actividad asistencial de CRG durante el periodo analizado experimentó un incremento del 109%. CaM y MM son las patologías que aglutinaron con diferencia una mayor demanda asistencial. La transferencia de competencias en estas dos patologías se ha producido de manera progresiva, asumiendo en 2022 el 74% (460/622) de la fase de administración el ERGC y el 64% (333/519) de las cirugías el TSID. Conclusiones: La creación de un equipo multidisciplinar de CRG, que incluye distintos perfiles profesionales (MN, ERGC y TSID), es una eficaz estrategia para dar respuesta al incremento de la complejidad y número de todos los procedimientos relacionados con la CRG.(AU)

Introduction: Given the constant increase in the healthcare demand for examinations related to radio-guided surgery (RGS), our hospital adopted new professional profiles in the RGS team, in order to partially reduce the time spent by nuclear medicine physicians on this task. Aim: To analyze the process of incorporating the profiles of Superior Diagnostic Imaging Technician (TSID) and Sentinel Node Referent Nurse (ERGC), evaluating their deployment in the procedures linked to the technique. Material and methods: Analysis of RGS activity during the period 2018-2022, focusing on pre-surgical and surgical procedures related to breast cancer (BC) and malignant melanoma (MM), as they are those pathologies on which the transfer of care competencies was concentrated. Chronological evolution of the competencies assumed by the different profiles during their integration into the RGS team. Results: RGS's healthcare activity during the analyzed period experienced an increase of 109%. BC and MM were the pathologies that accounted for by far the greatest demand for care. The transfer of competencies in these two pathologies occurred in a progressive and staggered manner, with 74% (460/622) of the administration phase being carried out by the ERGC and 64% (333/519) of the surgeries by the TSID in 2022. Conclusions: The creation of a multidisciplinary RGS team that includes different professional profiles (NM, ERGC and TSID) is an effective strategy to respond to the increase in the complexity and number of all procedures related to RGS.(AU)

Multidisciplinary radio-guided surgery team: Alternative to change the current paradigm.

INTRODUCTION: Given the constant increase in the healthcare demand for examinations related to radio-guided surgery (RGS), our hospital adopted new professional profiles in the RGS team, in order to partially reduce the time spent by nuclear medicine physicians on this task. AIM: To analyze the process of incorporating the profiles of Diagnostic Imaging Technician (DIT) and Sentinel Node Referent Nurse (SNRN), evaluating their deployment in the procedures linked to the technique. MATERIAL AND METHODS: Analysis of RGS activity during the period 2018-2022, focusing on pre-surgical and surgical procedures related to breast cancer (BC) and malignant melanoma (MM), as they are those pathologies on which the transfer of care competencies was concentrated. Chronological evolution of the competencies assumed by the different profiles during their integration into the RGS team. RESULTS: RGS's healthcare activity during the analyzed period experienced an increase of 109%. BC and MM were the pathologies that accounted for by far the greatest demand for care. The transfer of competencies in these two pathologies occurred in a progressive and staggered manner, with 74% (460/622) of the administration phase being carried out by the SNRN and 64% (333/519) of the surgeries by the DIT in 2022. CONCLUSIONS: The creation of a multidisciplinary RGS team that includes different professional profiles (nuclear medicine physician [MN], ERGC and TSID) is an effective strategy to respond to the increase in the complexity and number of all procedures related to RGS.

Perfil enfermera referente de ganglio centinela: descripción, validación y aplicación en la práctica asistencial / Sentinal lymph node reference nurse model: description, validation, and application in clinical practice

Introducción En 2019 se genera la oportunidad de integrar un enfermero en el equipo de cirugía radioguiada (CRG), adaptando el modelo de enfermera referente a las exploraciones de ganglio centinela (GC). Objetivos Describir el procedimiento adoptado para definir el perfil enfermera referente de ganglio centinela (ERGC), validar su aplicación práctica y establecer su implementación asistencial. Material y métodos Metodología de análisis y mejora continua en gestión de procesos (ciclo PDCA): definición y planificación de las funciones de ERGC en el protocolo de cáncer de mama, realización prueba piloto con 20 pacientes y análisis de los datos de cara a validar el circuito y establecer su implementación asistencial. Resultados Se elaboraron flujos del procedimiento, integrando la figura de ERGC. En la prueba piloto, un 15% de las mujeres presentaron un resultado positivo de ansiedad frente a un 60% de valoración subjetiva positiva de ansiedad. Tras las intervenciones enfermeras realizadas, se obtuvo una reducción del 58,3% en valoración subjetiva de ansiedad, un 100% de conocimiento de la prueba y una valoración del dolor en la administración del radiotrazador aceptable en las pacientes. En el nivel de calidad técnica, 8/10 ítems valorados consiguieron el objetivo previamente establecido por el equipo de CRG. Conclusiones La creciente complejidad de la técnica de biopsia de GC ha creado la oportunidad de implementar cuidados enfermeros en el procedimiento de localización prequirúrgica del GC. El perfil ERGC es el idóneo para llevarlo a cabo y ha conllevado mejoras objetivas en los diagnósticos enfermeros e ítems evaluados (AU)

Introduction In 2019 the opportunity to add a nurse within the radioguided surgery (RGS) team was generated. The referent nurse model was adapted to, the sentinel node (SN) preoperative approaches. Objectives To describe the process performed to define the sentinel node referentnurse (SNRN) profile, to validate its practical application and to establish its clinical implementation. Material and methods Methodology of analysis and continuous improvement in the management of processes (cycle PDCA): Definition and planning of the SNRN functions in the breast cancer protocol, performance of a pilot test with 20 patients and analysis of the data in order to validate the circuit and establish its final clinical implementation. Results New procedure flows-charts were elaborated, adding the figure of the SNRN, its function and nursing interventions during the process. In the pilot test a 58.3% reduction in subjective anxiety, a 75% decrease of the overall anxiety level, a 100% knowledge of the test and an acceptable patient perception of pain's level during the radiotracer administration were obtained. Regarding technical quality, 8/10 items assessed reached the level previously established by the RGS team. Conclusions The increasing complexity of the SN biopsy technique has created the opportunity to implement nursing care in the presurgical SN localization process. The profile of the SNRN is ideal for carrying it out and has led to improvements in the nursing diagnoses and assessed items (AU)

Sentinel node referent nurse: Description, validation and application in clinical practice.

INTRODUCTION: In 2019 the opportunity to add a nurse within the radioguided surgery (RGS) team was generated. The referent nurse model was adapted to, the sentinel node (SN) preoperative approaches. OBJECTIVES: To describe the process performed to define the sentinel node referent nurse (SNRN) profile, to validate its practical application and to establish its clinical implementation. MATERIAL AND METHODS: Methodology of analysis and continuous improvement in the management of processes (cycle PDCA): definition and planning of the SNRN functions in the breast cancer protocol, performance of a pilot test with 20 patients and analysis of the data in order to validate the circuit and establish its final clinical implementation. RESULTS: New procedure flows-charts were elaborated, adding the figure of the SNRN, its function and nursing interventions during the process. In the pilot test a 58.3% reduction in subjective anxiety, a 75% decrease of the overall anxiety level, a 100% knowledge of the test and an acceptable patient perception of pain's level during the radiotracer administration were obtained. Regarding technical quality, 8/10 items assessed reached the level previously established by the RGS team. CONCLUSIONS: The increasing complexity of the SN biopsy technique has created the opportunity to implement nursing care in the presurgical SN localization process. The profile of the SNRN is ideal for carrying it out and has led to improvements in the nursing diagnoses and assessed items.

Information on nosocomial infections in the mainstream media: an opinion document.

This paper seeks to explore the reasons for the low impact of nosocomial infection in the mainstream media and the responsibilities of physicians and journalists in terms of this situation. To this end, a small group of 13 experts met for round-table discussions, including physicians with expertise in nosocomial infection, medical lawsuits and ethics, as well as journalists from major mainstream Spanish media outlets. The various participants were asked a series of questions prior to the meeting, which were answered in writing by one of the speakers and discussed during the meeting by the whole group, the aim being to obtain consensual conclusions for each of them. The document was subsequently reviewed, edited and forwarded to all co-authors for their agreement. The opinions expressed are the personal opinions of the participants and not necessarily those of the institutions in which they work or with which they collaborate.

[Prevalence of diabetic retinopathy in the Regional Comunity of Extremadura. 1997-2001 (Extremadura Project to Prevent Blindness)]. / Prevalencia de retinopatía diabética en la Comunidad Autónoma de Extremadura. 1997-2001 (Proyecto Extremadura para Prevención de la Ceguera).

OBJECTIVE: To establish the prevalence of diabetic retinopathy (DR), types and risk factors in a diabetic population in Extremadura. METHODS: A cross-sectional study, with prospective data collection, was performed between 1997 and 2001 on 3,114 randomly selected diabetic patients belonging to 13 Diabetologic Assistance Centers. We evaluated: age, gender, type, treatment, duration of diabetes and blood pressure levels. Two color fundus photographs were taken and ophthalmoscopy was performed on both eyes. Data were analyzed using SPSS (11.5). RESULTS: The mean age of the patients was 63.8 (SD13.4) years, 7.5% were type 1 diabetics, 31.1% were insulin-treated and 46.0% had elevated blood pressure. Prevalence of DR was 35.7%, macular edema: 5.6% and proliferative DR: 5.3%. Multivariate analysis showed that type 1 diabetics have a DR frequency 1.79 times higher than type 2 diabetics (ORaj 1.79; IC 95% 1.22-2.63; p=0.003). Patients who have been diabetic for 5-10 years have a frequency 2 times higher (ORaj 2.00; IC 95% 1.62-2.45; p<0.001), patients diabetic for more than 15 years have a frequency 5.48 times higher (ORaj 5.48; IC 95% 4.33-6.93; p<0.001) than patients who have been diabetic for less than 5 years. The frequency of DR in patients aged more than 60 years is 23% higher than those under that age. (ORaj 1.23; IC 95% 1.01-1.50; p=0.045). CONCLUSIONS: 37.5% of the diabetic population in Extremadura is affected by diabetic retinopathy. New analyses are necessary in this population to detect the existence of other high risk subgroups in order to reduce these high prevalence levels.

Prevalencia de retinopatía diabética en la Comunidad Autónoma de Extremadura. 1997-2001 (Proyecto Extramadura para prevención de la ceguera) / Prevalence of diabetic retinopathy in the regional comunity of Extremadura. 1997-2001 (Extremadura Project to prevent blindness)

Objetivo: Determinar la prevalencia de retinopatía diabética (RD), de sus tipos y factores de riesgo en una población diabética de Extremadura.Métodos: Estudio transversal con recogida de la información prospectiva sobre 3.114 diabéticos procedentes de 13 centros de asistencia diabetológica seleccionados al azar entre 1997 y 2001. Se valoraron: edad, sexo, tipo, tratamiento y tiempo de evolución de la diabetes y diagnóstico de hipertensión arterial (HTA). Se realizaron dos retinografías por ojo además del estudio oftalmoscópico. Los datos fueron analizados mediante el SPSS (11.5).Resultados: La edad media fue 63,8 (DE 13,4) años, eran tipo 1 el 7,5%, insulin-tratados el 31,1% e hipertensos el 46%. La prevalencia de RD fue 35,7%, edema macular: 5,6% y RD proliferante: 5,3%. El análisis multivariante mostró que los tipo 1 tienen una frecuencia de RD 1,79 veces superior que los tipo 2 (ORaj 1,79; IC 95% 1,22-2,63; p=0,003). Los pacientes con evolución entre 5-10 años tienen una frecuencia 2 veces superior (ORaj 2,00; IC 95% 1,62-2,45; p<0,001) y los de más de 15 años 5,48 veces superior (ORaj 5,48; IC 95% 4,33-6,93; p<0,001) que los de menos de 5 años. Los pacientes de mas de 60 años tienen una frecuencia de RD un 23% superior a los pacientes con 60 años o menos (ORaj 1,23; IC 95% 1,01-1,50; p=0,045).Conclusiones: La retinopatía diabética afecta al 37,5% de la población diabética de la Comunidad Autónoma de Extremadura. Son necesarios nuevos análisis en esta población para detectar la existencia de subgrupos de riesgo que nos permitan actuar para reducir estas elevadas prevalencias

Objective: To establish the prevalence of diabetic retinopathy (DR), types and risk factors in a diabetic population in Extremadura.Methods: A cross-sectional study, with prospective data collection, was performed between 1997 and 2001 on 3,114 randomly selected diabetic patients belonging to 13 Diabetologic Assistance Centers. We evaluated: age, gender, type, treatment, duration of diabetes and blood pressure levels. Two color fundus photographs were taken and ophthalmoscopy was performed on both eyes. Data were analyzed using SPSS (11.5).Results: The mean age of the patients was 63.8 (SD13.4) years, 7.5% were type 1 diabetics, 31.1% were insulin-treated and 46.0% had elevated blood pressure. Prevalence of DR was 35.7%, macular edema: 5.6% and proliferative DR: 5.3%. Multivariate analysis showed that type 1 diabetics have a DR frequency 1.79 times higher than type 2 diabetics (ORaj 1.79; IC 95% 1.22-2.63; p=0.003). Patients who have been diabetic for 5-10 years have a frequency 2 times higher (ORaj 2.00; IC 95% 1.62-2.45; p<0.001), patients diabetic for more than 15 years have a frequency 5.48 times higher (ORaj 5.48; IC 95% 4.33-6.93; p<0.001) than patients who have been diabetic for less than 5 years. The frequency of DR in patients aged more than 60 years is 23% higher than those under that age. (ORaj 1.23; IC 95% 1.01-1.50; p=0.045).Conclusions: 37.5% of the diabetic population in Extremadura is affected by diabetic retinopathy. New analyses are necessary in this population to detect the existence of other high risk subgroups in order to reduce these high prevalence levels

Antibiotic resistance of Escherichia coli from community-acquired urinary tract infections in relation to demographic and clinical data.

This prospective study determined the antibiotic susceptibility of 164 isolates of Escherichia coli from the urine of 164 patients (112 female, 52 male; mean age of 54.12 years) with community-acquired urinary tract infection (UTI). Half of the isolates were from uncomplicated UTI and half from complicated UTI (52 males and 34 females). Overall, 57.3% of isolates were resistant to ampicillin, 25% to co-trimoxazole, 20.1% to nalidixic acid, 14% to norfloxacin and ciprofloxacin, and 0% to fosfomycin and nitrofurantoin. Of the 82 isolates from complicated UTI, 16 (19.5%) were resistant to norfloxacin and ciprofloxacin, compared with seven (8.5%) from uncomplicated UTI (p 0.043). Isolates from patients aged >50 years were significantly more resistant than those from patients aged <50 years for nalidixic acid (p 0.007) and the fluoroquinolones tested (p 0.015). Resistance to fluoroquinolones was 25% (13/52) in males and 9% (10/112) in females (p 0.006). For patients with and without previous antimicrobial therapy, there was a significant difference only for resistance to nalidixic acid (p < 0.001) and the fluoroquinolones (p 0.011). There were adequate susceptibility rates to fosfomycin, nitrofurantoin and the fluoroquinolones for empirical use in the treatment of acute uncomplicated UTI. In order to interpret cumulative susceptibility data from the primary healthcare setting, it is necessary to take into account the type of UTI (uncomplicated vs. complicated), previous antimicrobial therapy, and the sex and age of each patient.