Multicentre prospective study of drug-eluting bead chemoembolisation safety using tightly calibrated small microspheres in non-resectable hepatocellular carcinoma.

PURPOSE: To assess the safety and tolerability of transarterial drug-eluting bead chemoembolisation (DEB-TACE) using tightly calibrated 100-µm microspheres in hepatocellular carcinoma (HCC). METHOD: This multicentre prospective study included 131 patients with a 2-year follow-up. All patients had Child-Pugh scores ≤ B7, a good performance status, and Barcelona Clinic Liver Cancer stage A or B. Beads were loaded with 50 mg of doxorubicin per millilitre. Overall, 223 nodules were treated (mean size: 27.6 mm, average number of nodules per patient: 1.7). Toxicity was assessed using Common Terminology Criteria for Adverse Events 4.03 and response according to the modified Response Evaluation Criteria in Solid Tumours. The primary endpoint was safety. Secondary endpoints included technical success, post-embolisation syndrome (PES), local tumour response, and 2-year survival. RESULTS: A total of 214 DEB-TACE procedures were performed (mean per patient: 1.64), with a technical success rate of 97.6 % and a PES rate of 9.3 %. Major complications occurred in 6.8 % of patients and 4.1 % of procedures. There were no treatment-related deaths. Doxorubicin dose was an independent predictor of complications (p = 0.01). Four patients were lost to follow-up and 18 received liver transplants. Objective response rates were 74.6 %, 45.7 %, and 44.1 % at 6, 12, and 24 months, respectively. The cumulative 24-month overall survival rate was 55.96 %. Median survival was 22 months (interquartile range = 13-24). Co-morbidities and tumour response were independent predictors of survival (p = 0.0012 and 0.0052, respectively). Complications did not affect survival (p = 0.24). CONCLUSIONS: DEB-TACE with tightly calibrated 100-µm beads is safe and not associated with increases in biliary toxicity or complications. Tumour response and survival are in the expected range for chemoembolisation therapy. (Clinical trials ID: NCT02670122).

Migrant children's health problems, care needs, and inequalities: European primary care paediatricians' perspective.

BACKGROUND: Primary care paediatricians' perception of migrant children's health in Europe has not been explored before. Our aim was to examine European paediatricians' knowledge on migrant children's health problems, needs, inequalities, and barriers to access health care. METHODS: European primary care paediatricians were invited by the European Academy of Paediatrics Research in Ambulatory Setting Network country coordinators to complete a web-based survey concerning health care of migrant children. A descriptive analysis of all variables was performed. RESULTS: The survey was completed by 492 paediatricians. Sixty-three per cent of the respondents reported that the general health of migrant children is worse than that of nonmigrants, chronic diseases cited by 66% of the respondents as the most frequent health problem. Sixty-six per cent of the paediatricians reported that migrant children have different health needs compared to nonmigrant children, proper oral health care mentioned by 86% of the respondents. Cultural/linguistic factors have been reported as the most frequent barrier (90%).to access health care. However, only 37% of providers have access to professional interpreters and cultural mediators. Fifty-two per cent and 32% do not know whether one or more of the family members are undocumented and whether they are refugees/asylum seekers, respectively. Updated guidelines for care of migrant children are available for only 35% of respondents, and 80% of them have not received specific training on migrant children's care. CONCLUSIONS: European primary care paediatricians recognize migrant children as a population at risk with more frequent and specific health problems and needs, but they are often unaware of their legal state. Lack of interpreters augments the existing language barriers to access proper care and should be solved. Widespread lack of guidelines and specific providers' training should be addressed to optimize health care delivery to migrant children.

Diagnostic reference levels and complexity indices in interventional radiology: a national programme.

OBJECTIVES: To propose national diagnostic reference levels (DRLs) for interventional radiology and to evaluate the impact of the procedural complexity on patient doses. METHODS: Eight interventional radiology units from Spanish hospitals were involved in this project. The participants agreed to undergo common quality control procedures for X-ray systems. Kerma area product (KAP) was collected from a sample of 1,649 procedures. A consensus document established the criteria to evaluate the complexity of seven types of procedures. DRLs were set as the 3rd quartile of KAP values. RESULTS: The KAP (3rd quartile) in Gy cm2 for the procedures included in the survey were: lower extremity arteriography (n = 784) 78; renal arteriography (n = 37) 107; transjugular hepatic biopsies (THB) (n = 30) 45; biliary drainage (BD) (n = 314) 30; uterine fibroid embolization (UFE) (n = 56) 214; colon endoprostheses (CE) (n = 31) 169; hepatic chemoembolization (HC) (n = 269) 303; femoropopliteal revascularization (FR) (n = 62) 119; and iliac stent (n = 66) 170. The complexity involved the increases in the following KAP factors from simple to complex procedures: THB x4; BD x13; UFE x3; CE x3; HC x5; FR x5 and IS x4. CONCLUSIONS: The evaluation of the procedure complexity in patient doses will allow the proper use of DRLs for the optimization of interventional radiology. KEY POINTS: • National DRLs for interventional procedures have been proposed given level of complexity • For clinical audits, the level of complexity should be taken into account. • An evaluation of the complexity levels of the procedure should be made.

Documento de consenso sobre etiología, diagnóstico y tratamiento de la otitis media aguda / Consensus document on the aetiology, diagnosis and treatment of acute otitis media

Se presenta el documento de consenso sobre otitis media aguda (OMA) de la Sociedad de Española Infectología Pediátrica (SEIP), Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria (SEPEAP), Sociedad Española de Urgencias Pediátricas (SEUP) y de la Asociación Española de Pediatría de Atención Primaria (AEPAP).Se analizan la etiología de la enfermedad y los posibles cambios de esta después de la introducción de la vacunas antineumocócicas 7-valente, 10-valente y 13-valente. Se hace una propuesta diagnóstica basada en la clasificación de la otitis media aguda en confirmada o probable. Se considera OMA confirmada si hay coincidencia de 3 criterios: comienzo agudo, signos de ocupación del oído medio (u otorrea) y signos o síntomas inflamatorios, como otalgia o intensa hiperemia timpánica y OMA probable cuando existan solo 2 criterios. Se propone como tratamiento antibiótico de elección la amoxicilina oral a 80mg/kg/día repartido cada 8 h. El tratamiento con amoxicilina-ácido clavulánico a dosis de 80mg/kg/día se indica si el niño es menor de 6 meses, en lactantes con clínica grave (fiebre>39°C o dolor muy intenso), cuando haya historia familiar de secuelas óticas por OMA o un fracaso terapéutico de la amoxicilina(AU)

This is the consensus document on acute otitis media (AOM) of the Sociedad Española de Infectología Pediatrica (SEIP), Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria (SEPEAP), Sociedad Española de Urgencias Pediátricas (SEUP) and Asociación Española de Pediatría de Atención Primaria (AEPAP). It discusses the aetiology of the disease and its potential changes after the introduction of the pneumococcal 7-valent, 10-valent and 13-valent vaccines. A proposal is made based on diagnostic classification of otitis media as either confirmed or likely. AOM is considered confirmed if 3 criteria are fulfilled: acute onset, signs of occupation of the middle ear (or otorrhea) and inflammatory signs or symptoms, such as otalgia or severe tympanic hyperaemia. Oral amoxicillin is the antibiotic treatment of choice (80mg/kg/day divided every 8hours). Amoxicillin-clavulanate (80mg/kg/day) is indicated in the following cases: when the child is under 6 months, in infants with severe clinical manifestations (fever>39°C or severe pain), there is family history of AOM sequels, and after amoxiciline treatment failure(AU)

Fuentes de información bibliográfica (XVII). Pediatría basada en la evidencia y bases de datos de guías de práctica clínica / Sources of bibliographic information (XVII). Evidence-based paediatrics and database of clinical practice guidelines

Las guías de práctica clínica son un conjunto de recomendaciones desarrolladas de forma sistemática para ayudar a los profesionales y los pacientes a tomar decisiones sobre la atención sanitaria más apropiada, y a seleccionar las opciones diagnósticas o terapéuticas más adecuadas a la hora de abordar un problema de salud o una afección clínica específica. Enumeramos las características de los principales centros elaboradores de guías (SIGN, NICE, GuiaSalud, etc.) y de los centros de almacenamiento para su recuperación (National Guideline Clearinghouse, Guideline International Network, GuiaSalud)(AU)

Clinical practice guidelines are systematically developed statements to assist practitioners and patient decisions about appropriate health care and to select the most appropriate therapeutic and diagnostic options for specific clinical circumstances. We describe the characteristics of the most relevant guidelines resources (SIGN, NICE, GuiaSalud, etc.) and the main databases for evidence-based clinical practice guidelines (National Guideline Clearinghouse, Guideline International Networf, GuiaSalud)(AU)

Documento de consenso sobre etiología, diagnóstico y tratamiento de la otitis media aguda / Consensus document on the aetiology, diagnosis and treatment of acute otitis media

Se presenta el documento de consenso sobre otitis media aguda (OMA) de la Sociedad Española de Infectología Pediátrica (SEIP), la Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria (SEPEAP), la Sociedad Española de Urgencias Pediátricas (SEUP) y la Asociación Española de Pediatría de Atención Primaria (AEPap). Se analizan la etiología de la enfermedad y los posibles cambios de esta después de la introducción de la vacunas antineumocócicas 7-valente, 10-valente y 13-valente. Se hace una propuesta diagnóstica basada en la clasificación de la OMA en confirmada o probable. Se considera OMA confirmada si hay coincidencia de tres criterios: comienzo agudo, signos de ocupación del oído medio (u otorrea) y signos o síntomas inflamatorios, como otalgia o intensa hiperemia timpánica, y OMA probable cuando existan solo dos criterios. Se propone como tratamiento antibiótico de elección la amoxicilina oral en dosis de 80 mg/kg/día repartidas cada ocho horas. El tratamiento con amoxicilina-ácido clavulánico en dosis de 80 mg/kg/día se indica si el niño es menor de seis meses, en lactantes con clínica grave (fiebre >39 ºC o dolor muy intenso), cuando haya historia familiar de secuelas óticas por OMA o un fracaso terapéutico de la amoxicilina(AU)

We present the consensus document on acute otitis media (AOM) written by the Spanish Society of Pediatric Infectology (SEIP), the Spanish Society of Outpatient and Primary Care Pediatrics (SEPEAP), the Spanish Society of Pediatric Emergency Care (SEUP) and the Spanish Association of Primary Care Pediatrics (AEPAP). The document analyses the etiology of the disease and the possible shifts in it following the introduction of the 7-valent, 10-valent, and 13-valent pneumococcal vaccines. The document proposes diagnosing AOM as confirmed or probable. The AOM diagnosis is considered confirmed if three criteria are met: acute onset, signs of fluid in the middle ear (or otorrhea), and symptoms of inflammation, such as otalgia or marked erythema in the middle ear, and considered probable when only two of these criteria are met. The proposed first choice for antibiotic treatment is 80 mg/kg/day of amoxicillin administered orally in doses at eight hour intervals. Treatment with amoxicillin-clavulanic acid in doses of 80 mg/kg/day are indicated in children younger than six months, in infants with a severe presentation (fever >39 °C or acute pain), when there is a family history of AOM sequelae, or in cases of amoxicillin treatment failure(AU)

[Consensus document on the aetiology, diagnosis and treatment of acute otitis media]. / Documento de consenso sobre etiología, diagnóstico y tratamiento de la otitis media aguda.

This is the consensus document on acute otitis media (AOM) of the Sociedad Española de Infectología Pediatrica (SEIP), Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria (SEPEAP), Sociedad Española de Urgencias Pediátricas (SEUP) and Asociación Española de Pediatría de Atención Primaria (AEPAP). It discusses the aetiology of the disease and its potential changes after the introduction of the pneumococcal 7-valent, 10-valent and 13-valent vaccines. A proposal is made based on diagnostic classification of otitis media as either confirmed or likely. AOM is considered confirmed if 3 criteria are fulfilled: acute onset, signs of occupation of the middle ear (or otorrhea) and inflammatory signs or symptoms, such as otalgia or severe tympanic hyperaemia. Oral amoxicillin is the antibiotic treatment of choice (80mg/kg/day divided every 8hours). Amoxicillin-clavulanate (80mg/kg/day) is indicated in the following cases: when the child is under 6 months, in infants with severe clinical manifestations (fever>39°C or severe pain), there is family history of AOM sequels, and after amoxiciline treatment failure.

Guías de certificación de la Sociedad Española de Radiología (SERAM) y la Sociedad Española de Radiología Vascular e Intervencionista (SERVEI) sobre requerimientos y equipamiento en radiología vascular intervencionista / No disponible

No disponible