Epidemiología del ictus cardioembólico y su asociación con la penetración de los ACOD en España: primer estudio poblacional 2005-2018 / Epidemiology of atrial fibrillation-related ischemic stroke and its association with DOAC uptake in Spain: first national population-based study 2005 to 2018

Introducción y objetivos: La prevalencia y la incidencia de la fibrilación auricular (FA), un importante factor de riesgo de ictus cardioembólico, han aumentado sustancialmente en los últimos años. Sin embargo, varios estudios europeos han observado una disminución en la tasa de ictus cardioembólico asociada con un aumento de la penetración de los anticoagulantes orales de acción directa (ACOD). Este estudio ecológico evalúa la asociación entre la penetración de los ACOD y la tasa de incidencia de ictus cardioembólicos en España. Métodos: Los datos se obtuvieron del Registro de Actividad Sanitaria Especializada del Ministerio de Sanidad de España (RAE-CMBD). Los ictus cardioembólicos se identificaron mediante códigos ICD. Las tasas de incidencia se estandarizaron por edad y se ajustaron a la población estándar europea de 2013. Se utilizaron modelos de regresión de Poisson para estimar la asociación entre la penetración de los ACOD y la tasa de ictus cardioembólico en pacientes de 65 o más años. Resultados: La tasa de incidencia ajustada (TI) del ictus cardioembólico aumentó desde 2005 (2,20/100.000 personas/año) hasta 2012 (2,67). A partir de 2012, tras la introducción de los ACOD para la prevención del ictus cardioembólico en España, la TI se ha mantenido constante o ha disminuido ligeramente (en 2018, 2,66). Los resultados del modelo de regresión de Poisson indican que la penetración de los ACOD tiene una influencia estadísticamente significativa en la tasa de ictus cardioembólicos de los mayores de 65 años (RDI=0,995; IC95%, 0,995-0,996). Conclusiones: Los resultados de este estudio muestran una asociación entre la penetración de los ACOD y una menor incidencia de ictus cardioembólicos. A pesar de que esta asociación no implica causalidad, indica que una mayor penetración de los ACOD podría llevar a un mayor beneficio clínico para los pacientes con FA en España (AU)

Introduction and objectives: The incidence and prevalence of atrial fibrillation (AF), a major risk factor for stroke, has increased substantially in the past few years. However, several studies have reported a decline in AF-related stroke rates associated with higher uptake of direct oral anticoagulants (DOACs). This ecological study evaluated the association between DOAC uptake in Spain and the incidence rate (IR) of AF-related ischemic stroke. Methods: Data were obtained from the Registry of Activity of Specialized Healthcare of the Spanish Ministry of Health (RAE-MDS). AF-related ischemic strokes were identified using International Classification of Diseases codes. IR were age-standardized and adjusted to the 2013 European standard population. Poisson regression models were used to identify the association between DOAC uptake and AF-related ischemic stroke in patients aged ≥ 65 years. Results: Before the use of DOACs, the adjusted IR of AF-related ischemic stroke increased steadily from 2005 (IR=2.20 per 100 000 person/y) to 2012 (IR=2.67). Upon DOAC uptake in Spain from 2012 onwards for AF-related ischemic stroke prevention, the IR remained constant or decreased slightly (IR in 2018=2.66). Poisson regression showed that DOAC uptake was a significant predictor for the rate of AF-related ischemic stroke in patients older than 65 years (IRR=0.995; 95%CI, 0.995-0.996). Conclusions: This study shows an association between DOAC use and a reduced incidence of AF-related ischemic stroke. While this association is based on aggregate data and cannot demonstrate causality, these findings suggest that higher DOAC uptake could improve health outcomes in AF patients in Spain (AU)

Estado actual de la labor de los fisioterapeutas en las unidades de cuidados intensivos de adultos del área metropolitana de Barcelona / Current physiotherapists' role in adult intensive care units in the metropolitan area of Barcelona

Antecedentes y objetivo: Los fisioterapeutas son un grupo de profesionales con importancia creciente dentro de las unidades de cuidados intensivos (UCI). Sin embargo, tanto sus prácticas terapéuticas como su disponibilidad en estas unidades son muy heterogéneas. El objetivo de este trabajo fue evaluar la variabilidad en cuanto a disponibilidad, actividades terapéuticas, formación y entorno de trabajo de los fisioterapeutas de las UCI de adultos en Barcelona. Materiales y métodos: Se realizó un estudio transversal y descriptivo a través de dos cuestionarios que se diseñaron para ser contestados por los jefes de servicio y por los fisioterapeutas de las UCI de adultos del área metropolitana de Barcelona durante marzo y abril de 2018. Resultados: Se contestaron 19/21 cuestionarios de jefes de servicio y 23/29 de fisioterapeutas. Todas las UCI disponían de servicio de fisioterapia en días laborables, con una ratio -mediana (rango intercuartílico, p25-p75)- de 13 (11,5, 5,5-17) camas UCI por fisioterapeuta, dedicando la mayoría (65%) un promedio de 16-30 min por paciente. La disponibilidad en festivos era del 47% de los casos, y no se ofrecía fisioterapia en horario nocturno. El trabajo de los fisioterapeutas fue considerado satisfactorio por la mayoría de los jefes de servicio, si bien se consideraban insuficientes en número y en tiempo de dedicación para cubrir las necesidades. Las actividades terapéuticas fueron variables entre los participantes. Conclusiones: La disponibilidad de los fisioterapeutas en las UCI de adultos de Barcelona es variable, siendo significativamente inferior a las recomendaciones europeas y nacionales vigentes. Existen también diferencias entre las actividades terapéuticas realizadas entre ellos

Background and objective: Physiotherapists are a group of professionals with increasing importance within the intensive care units (ICU). However, both their therapeutic practices and their availability for these units are very heterogeneous. The aim of this study was to evaluate the variability in terms of availability, therapeutic activities, training and work environment of the physiotherapists of adult ICU in Barcelona. Materials and methods: A cross-sectional and descriptive study was carried out through two questionnaires that were designed to be answered by department heads and physiotherapists of adult ICU in the metropolitan area of Barcelona, from March to April 2018. Results: Nineteen of 21 questionnaires for head physicians and 23/29 for physiotherapists were answered. All ICU had a physiotherapy service on weekdays, with a median (IQR, p25-p75) ratio of 1 physiotherapist for every 13 (11.5, 5.5-17) ICU beds. Most of the physiotherapists (65%) spent 16-30 minutes per patient. Availability on holidays was 47%, and there were no physiotherapists during the night-shifts. Physiotherapist assistance was considered satisfactory by most head physicians, although it was also considered insufficient both in number and time to meet patients' needs. Therapeutic activities were different among participants. Conclusions: Physiotherapist availability in adult ICU in Barcelona was variable and significantly below current European and national recommendations. There were also differences in therapeutic activities among them

Validación de la versión española del cuestionario Bladder Pain/Interstitial Cystitis-Symptom Score (BPIC-SS). Un instrumento útil para el diagnóstico del síndrome de dolor vesical / Validation of the Spanish version of the Bladder Pain/Interstitial Cystitis-Symptom Score (BPIC-SS) questionnaire. A useful tool for the diagnosis of bladder pain syndrome

Objetivos: Evaluar las propiedades psicométricas de la versión española del cuestionario Bladder Pain/Interstitial Cystitis-Symptom Score (BPIC-SS) en el diagnóstico de pacientes con síndrome de dolor vesical (SDV) en las Unidades de Urología Funcional, Femenina y Urodinámica en España. Material y métodos: La adaptación de la versión española del BPIC-SS fue evaluada en 243 pacientes con SDV. Los pacientes completaron los cuestionarios EQ-5D-5L, Patient Perception of Bladder Condition (PPBC) y el cuestionario de impresión global según la gravedad de la sintomatología (CGI-S). Se evaluó la consistencia, la fiabilidad test-retest en pacientes sin cambios clínicos a los 15 días, la validez de criterio y la sensibilidad al cambio en pacientes con cambios clínicos a los 6 meses. El punto de corte para discriminar pacientes con SDV de otras patologías similares se analizó mediante curva ROC. Resultados: La puntuación media (DE) del BPIC-SS (0-38) fue de 16,2 (12,0) puntos. El alfa de Cronbach fue de 0,92 y el coeficiente correlación intraclase (CCI) fue de 0,82, oscilando entre 0,5-0,9 por ítem. La validez convergente determinó una correlación de 0,63 con PPBC y -0,40 con la Escala Visual Analógica (EVA) del EQ-5D-5L, y el tamaño del efecto en pacientes que mejoraron su estado clínico fue de 1,9. Se ha establecido como punto de corte para el diagnóstico de SDV una puntuación del BPIC-SS superior o igual a 12 puntos (87,5% de sensibilidad y 91,9% de especificidad). Conclusiones: La versión española del cuestionario BPIC-SS es un instrumento válido, fiable y sensible al cambio para la evaluación de pacientes con SDV

Objectives: Validation of the Spanish version of the Bladder Pain/Interstitial Cystitis-Symptom Score (BPIC-SS) questionnaire to evaluate its utility for the diagnosis of Bladder Pain Syndrome (BPS) patients in the Female and Urodynamics Urology Functional Units in Spain. Material and methods: The Spanish adaptation of the BPIC-SS questionnaire was evaluated in 243 BPS patients. EQ-5D-5L, Patient Perception of Bladder Condition (PPBC) and global impression questionnaire (CGI-S) were collected. Consistency, test-retest reliability in patients without clinical changes at 15 days, criterion validity and sensitivity to change were assessed in BPS patients with clinical changes at 6 months. The cut-off point for discriminating BPS patients from other similar pathologies (Hyperactive Bladder or other urinary pathologies) was analysed using ROC curve. Results: Mean (SD) BPIC-SS score (0-38) was 16.2 (12.0) points. Cronbach's alpha was 0.92 and intraclass coefficient correlation (ICC) was 0.82, ranging from 0.5-0.9 per item. Convergent validity determined a Spearman correlation of 0.63 with PPBC and -0.40 with EQ-5D-5L Visual Analogue Scale (VAS) and the effect size obtained in patients who improved their clinical status was 1.9. A score greater than or equal to 12 points in the BPIC-SS has been established as the best cut-off point for the diagnosis of BPS (87.5% sensitivity and 91.9% specificity). Conclusions: The Spanish version of the BPIC-SS is a valid and reliable instrument for the diagnosis and follow-up of patients with BPS in Spain

Validation of the Spanish version of the Bladder Pain/Interstitial Cystitis-Symptom Score (BPIC-SS) questionnaire. A useful tool for the diagnosis of bladder pain syndrome. / Validación de la versión española del cuestionario Bladder Pain/Interstitial Cystitis-Symptom Score (BPIC-SS). Un instrumento útil para el diagnóstico del síndrome de dolor vesical.

OBJECTIVES: Validation of the Spanish version of the Bladder Pain/Interstitial Cystitis-Symptom Score (BPIC-SS) questionnaire to evaluate its utility for the diagnosis of Bladder Pain Syndrome (BPS) patients in the Female and Urodynamics Urology Functional Units in Spain. MATERIAL AND METHODS: The Spanish adaptation of the BPIC-SS questionnaire was evaluated in 243 BPS patients. EQ-5D-5L, Patient Perception of Bladder Condition (PPBC) and global impression questionnaire (CGI-S) were collected. Consistency, test-retest reliability in patients without clinical changes at 15 days, criterion validity and sensitivity to change were assessed in BPS patients with clinical changes at 6 months. The cut-off point for discriminating BPS patients from other similar pathologies (Hyperactive Bladder or other urinary pathologies) was analysed using ROC curve. RESULTS: Mean (SD) BPIC-SS score (0-38) was 16.2 (12.0) points. Cronbach's alpha was 0.92 and intraclass coefficient correlation (ICC) was 0.82, ranging from 0.5-0.9 per item. Convergent validity determined a Spearman correlation of 0.63 with PPBC and -0.40 with EQ-5D-5L Visual Analogue Scale (VAS) and the effect size obtained in patients who improved their clinical status was 1.9. A score greater than or equal to 12 points in the BPIC-SS has been established as the best cut-off point for the diagnosis of BPS (87.5% sensitivity and 91.9% specificity). CONCLUSIONS: The Spanish version of the BPIC-SS is a valid and reliable instrument for the diagnosis and follow-up of patients with BPS in Spain.

How can we measure bladder volumes in women with advanced pelvic organ prolapse?

OBJECTIVES: To compare bladder volumes determined by three different formulae using measurements obtained from two-dimensional translabial ultrasound (2D-US), with true bladder volumes, in women with advanced pelvic organ prolapse (POP). METHODS: This was a prospective observational multicenter study of consecutive women on the waiting list for prolapse surgery in 24 gynecology departments. All women had a symptomatic genital prolapse Stage 2 or higher according to the Pelvic Organ Prolapse Quantification System (POP-Q). Bladder volumes were calculated before and after spontaneous voiding by 2D-US, and true bladder volumes were determined by micturition and catheterization. Volumes determined by US were calculated using three formulae (Haylen, Dietz and Dicuio). Correlation was calculated between the volume determined by US measurement before micturition and the true volume, and also between the volume determined by US measurements after micturition and the true volume. Correlations (Spearman's rho) and concordance (intraclass correlation coefficient (ICC)) were estimated for each of the three formulae considered. RESULTS: One-hundred and eighty-six women with POP were included in the study. A total of 349 bladder volumes (186 before micturition and 163 after micturition) were obtained. Good correlation (rho, 0.818-0.849) and concordance (ICC, 0.827-0.898) were found between total measured volume (volume of spontaneous bladder voiding + volume obtained from catheterization) and the volume determined by US using the three different formulae, as well as between the post-void residual volume measured by catheterization and the post-void volume calculated by US using the three formulae (rho, 0.739-0.777; ICC, 0.840-0.877). CONCLUSIONS: Bladder volumes in women with advanced POP can be measured easily by 2D-US. Volumes determined using the three different formulae show good correlations and concordance with true bladder volume.

Descripción de dos casos de shock hemorrágico por arteritis infecciosa secundaria a sepsis urinaria / Two cases of hemorrhagic shock due to septic arteritis secondary to urinary tract infection

La arteritis infecciosa es una entidad considerada rara y atribuida únicamente a determinados agentes con infección crónica como la lúes. Sin embargo, su incidencia puede ser más elevada de lo esperado, ya que puede complicar cuadros sépticos como los de origen urinario. Mayoritariamente se diagnostican cuando se complican, habitualmente en forma de ruptura y hemorragia oculta, a menudo mortal. Se describen dos casos de shock séptico urinario complicados con una arteritis infecciosa precoz que condicionó la ruptura de los vasos afectados y un shock hemorrágico posterior. El urgenciólogo debe estar alerta frente a esta posibilidad, dada su potencial gravedad y la necesidad de un tratamiento agresivo precoz (AU)

Infectious, or septic, arteritis is a rare condition attributed only to certain chronic infections, such as syphilis. The incidence of septic arteritis may be higher than supposed, however, as it may be a complication of certain other infections, such as those in the urinary tract. Septic arteritis is usually diagnosed when the patient develops acomplication, such as ruptured vessels or occult bleeding, and such events often end in death. We describe 2 cases of septic shock originating in complicated urinary tract infections with early septic arteritis that led the affected vessels to rupture; hemorrhagic shock followed. The emergency physician should be alert to the possibility of these potentially serious events and be prepared to treat the condition quickly and aggressively (AU)

Preferencia hacia los tratamientos para la disfunción eréctil: evaluación mediante la técnica de «análisis conjunto» / Preference for erectile dysfunction treatments: Assessment by means of consumers preference analysis techniques

Introducción: La preferencia hacia medicamentos para la disfunción eréctil (DE) es fundamental para la satisfacción y la adherencia. Analizamos la utilidad de la principal técnica de estimación de preferencias en consumidores (análisis conjunto) para valorar la preferencia hacia estos tratamientos y analizamos la influencia de la edad, la frecuencia de relaciones sexuales, las comorbilidades, la gravedad de la DE y la presencia de síndrome de déficit de testosterona (SDT). Material y método: Estudio observacional, transversal, multicéntrico en 626 varones con edad ≥ 18 años que tomaron al menos 2 iPDE5 diferentes recientemente, uno de ellos vardenafilo bucodispersable. Se valoraron 7 atributos de tratamientos para DE seleccionados. Se crearon escenarios (cartas) con combinaciones de atributos: 2 series contenían 4 atributos (9 cartas), otra 7 (16 cartas). Las series cortas se testaron en atención primaria, la larga en urología/andrología. La influencia sobre las preferencias se analizó mediante regresión logística de rangos ordenados. Resultados: La forma de administración fue consistentemente el atributo con mayor importancia relativa y la forma bucodispersable el de mayor utilidad. Solo una serie corta logró un consenso hacia la combinación preferida y no preferida. Únicamente la gravedad de los síntomas del SDT, o la presencia de los más frecuentes, afectó levemente a la preferencia. Conclusiones: El análisis conjunto es válido para el análisis de preferencias hacia tratamientos para la DE. Es necesaria una serie corta de atributos muy seleccionados. La facilidad y comodidad de administración son de gran importancia para los usuarios. La sintomatología del SDT afecta levemente a las preferencias

Introduction: Patient preference for erectile dysfunction (ED) treatments is of great importance for satisfaction and adherence. We have assessed the usefulness of the main technique for assessing consumer preferences (conjoint analysis) to analyze preferences towards these treatments. We also assessed the influence of age, frequency of sexual intercourse, co-morbidities, ED severity or having testosterone deficiency syndrome (TDS). Materials and methods: Observational, cross-sectional, multicenter study in 626 men aged ≥ 18 years who had recently taken at least two different PDE5i, one being vardenafil orodispersible (ODT). Seven selected features of ED treatments were tested. Different series of scenarios (cards) were created by combining these features: two series of 4 features (9 cards), another one series of 7 (16 cards). Short series were tested in Primary Care, and the long series in Urology/Andrology offices. Influences were tested by rank ordered logistic regression analysis. Results: The feature «administration form» was consistently given the most relative importance; the ODT form was given the greatest utility. Consensus towards the most and least preferred treatment was achieved only in one of the short series tested. Only severity of TDS symptoms, or having the most frequent symptoms, influenced treatment preference. Influence was mild. Conclusions: Conjoint analysis is a valid method for assessing preferences for ED treatments. A short series of highly selected attributes is advisable. Easiness and convenience of administration are of great importance for users. TDS symptomatology mildly affects preference

Dosificación de cidofovir en un paciente crítico en hemodiafiltración continua venovenosa / Cidofovir dosage in a critically ill patient undergoing continuous veno-venous hemodiafiltration

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Preference for erectile dysfunction treatments: Assessment by means of consumers preference analysis techniques.

INTRODUCTION: Patient preference for erectile dysfunction (ED) treatments is of great importance for satisfaction and adherence. We have assessed the usefulness of the main technique for assessing consumer preferences (conjoint analysis) to analyze preferences towards these treatments. We also assessed the influence of age, frequency of sexual intercourse, co-morbidities, ED severity or having testosterone deficiency syndrome (TDS). MATERIAL AND METHOD: Observational, cross-sectional, multicenter study in 626 men aged ≥18 years that had recently taken at least two different PDE5i, one being vardenafil orodispersible (ODT). Seven selected features of ED treatments were tested. Different series of scenarios (cards) were created by combining these features: two series of 4 features (9 cards), another one series of 7 (16 cards). Short series were tested in Primary Care, and the long series in Urology/Andrology offices. Influences were tested by rank ordered logistic regression analysis. RESULTS: The feature «administration form¼ was consistently given the most relative importance; the ODT form was given the greatest utility. Consensus towards the most and least preferred treatment was achieved only in one of the short series tested. Only severity of TDS symptoms, or having the most frequent symptoms, influenced treatment preference. Influence was mild. CONCLUSIONS: Conjoint analysis is a valid method for assessing preferences for ED treatments. A short series of highly selected attributes is advisable. Easiness and convenience of administration are of great importance for users. TDS symptomatology mildly affects preference.

Associations of Body Mass Index (Maternal BMI) and Gestational Diabetes Mellitus with Neonatal and Maternal Pregnancy Outcomes in a Multicentre European Database (Diabetes and Pregnancy Vitamin D and Lifestyle Intervention for Gestational Diabetes Mellitus Prevention).

Objective. Assess the impact of Gestational Diabetes Mellitus (GDM) and obesity on neonatal and maternal pregnancy outcomes. Methods. Cross-sectional data (3343 pregnancies) from seven European centres were included in a multilevel analysis of the association between GDM/obesity and caesarean section, macrosomia and neonatal morbidities. Results. Comparison of databases identified reporting differences between countries due to the inclusion of true population based samples or pregnancies from specialised tertiary centres, resulting in higher prevalences of GDM for some countries. The analysis showed that obesity and GDM were independent risk factors of perinatal complications. Only BMI had a dose-dependent effect on the risk of macrosomia and caesarean section. Both obesity (BMI > 30 kg/m(2)) and GDM were independent risk factors of neonatal morbidities. Conclusions. Obesity and GDM were independent risk factors of perinatal complications. The effect of the worldwide obesity and diabetes epidemic is extending to the next generation.