Meningococcal meningitis in Spain in the Horizon 2030: A position paper.

Meningococcal meningitis (MM) and invasive meningococcal disease remain a major public health problem that generates enormous public alarm. It is caused by Neisseria meningitidis, a Gram-negative diplococcus with an enormous capacity for acute and rapidly progressive disease, both episodic and epidemic in nature, with early diagnosis and treatment playing a major role. It occurs at any age, but is most common in children under 5 years of age followed by adolescents. Although most cases occur in healthy people, the incidence is higher in certain risk groups. Despite advances in reducing the incidence, it is estimated that in 2017 there were around 5 million new cases of MM worldwide, causing approximately 290,000 deaths and a cumulative loss of about 20,000,000 years of healthy life. In Spain, in the 2021/22 season, 108 microbiologically confirmed cases of MM were reported, corresponding to an incidence rate of 0.23 cases per 100,000 inhabitants. This is a curable and, above all, vaccine-preventable disease, for which the World Health Organisation has drawn up a roadmap with the aim of reducing mortality and sequelae by 2030. For all these reasons, the Illustrious Official College of Physicians of Madrid (ICOMEM) and the Medical Associations of 8 other provinces of Spain, have prepared this opinion document on the situation of MM in Spain and the resources and preparation for the fight against it in our country. The COVID-19 and Emerging Pathogens Committee of ICOMEM has invited experts in the field to participate in the elaboration of this document.

A strategy for patient involvement in clinical practice guidelines: methodological approaches.

BACKGROUND An increasing number of initiatives involve patients in the development of Clinical Practice Guidelines (CPGs). However, the method used for patient involvement is fundamental to achieving a quality patient-oriented CPG. The objective is to present a strategy for patient involvement that includes both robust patient consultation and participation. This strategy is based on the authors' experience in the development of four CPGs included in the Spanish National CPG Development Program, which deemed it a valuable nation-wide patient involvement initiative. METHODS Patient consultation in the CPG preparation phase combines quantitative and qualitative primary research techniques as well as a systematic review of patient-perspective studies. Participation relies on patients and patient representatives as members of the guideline development groups in all development phases at the same level as professionals. NVivo 8 software was used to analyse discourses of qualitative data. RESULTS Patients and patient representatives provided relevant information on their perspectives, experiences with the illness, social circumstances, habits, values and preferences. They collaborated in different CPG development phases, including setting the scope and objectives, defining key research questions, writing and reviewing recommendations, developing patients' versions and the dissemination of CPGs. CONCLUSIONS The authors' strategy allows for patient-oriented CPG development, but it requires appropriate training and knowledge of qualitative research techniques (primary research and systematic review of qualitative evidence) for developers. It is also crucial to have specific support for patients, previously selected with eligibility criteria, to facilitate an effective engagement, providing clear guidance on their roles and ensuring opportunities to attend training events.

Meta-analysis of observational studies on the safety and effectiveness of robotic gynaecological surgery.

BACKGROUND: The safety and effectiveness of robotic, open and conventional laparoscopic surgery in gynaecological surgery was assessed in a systematic review of the literature. This will enable the general surgical community to understand where robotic surgery stands in gynaecology. METHODS: A search was made for previous systematic reviews in the Abstracts of Reviews of Effects, Health Technology Assessment, Cochrane Collaboration and Hayes Inc. databases. In addition, the MEDLINE, Embase and CINAHL databases were searched for primary studies. The quality of studies was assessed and meta-analyses were performed. RESULTS: Twenty-two studies were included in the review. All were controlled but none was randomized. The majority were retrospective with historical controls. The settings in which robotic surgery was used included hysterectomy for malignant and benign disease, myomectomy, sacrocolpopexy, fallopian tube reanastomosis and adnexectomy. Robotic surgery achieved a shorter hospital stay and less blood loss than open surgery. Compared with conventional laparoscopic surgery, robotic surgery achieved reduced blood loss and fewer conversions during the staging of endometrial cancer. No clinically significant differences were recorded for the other indications tested. CONCLUSION: The available evidence shows that robotic surgery offers limited advantages with respect to short-term outcomes. However, the clinical outcomes should be interpreted with caution owing to the methodological quality of the studies.

A systematic review of FDG-PET in breast cancer.

OBJECTIVE: To assess the safety and efficacy of FDG-PET in breast cancer in the diagnostic of primary tumours, lymph node staging, the detection of recurrent disease/metastases, and the assessment of chemotherapy treatment. METHODS: A systematic review was undertaken. A search was made for primary studies, other systematic reviews, and health technology assessment reports in different databases. RESULTS: A total of 73 reports were included. FDG-PET does not appear to be sufficiently accurate to be used in isolation for ruling out the presence of a primary tumour. In lymph gland staging, FDG-PET does not appear to be accurate enough to detect occult axillary metastases or micrometastases (sensitivity 20 and 50%, respectively); sentinel node biopsy is required for confirmation. In the detection of bone metastases, FDG-PET should be complemented with other tests such as bone gammagraphy or SPECT. The assessment of response to chemotherapy, there seems to be no uniform criterion for establishing a standardized uptake value (SUV) for FDG that would allow responders and non-responders to be distinguished. CONCLUSIONS: FDG-PET is insufficiently sensitive to rule out small primary tumours. Due to the high number of false positives returned, it cannot replace axillary dissection in axillary lymph gland staging. A complete biochemical response identified by FDG-PET should not be relied upon to mean an absence of disease since the technique cannot detect residual microscopic elements.

Systematic review of laparoscopic versus open surgery for colorectal cancer.

BACKGROUND: This study compares the efficacy and safety of laparoscopic surgery (LS) and open surgery (OS) for colorectal cancer. METHODS: An electronic search of the literature was undertaken to identify primary studies and systematic reviews. Information on the efficacy and safety of LS versus OS was analysed. A meta-analysis was conducted to examine long-term outcomes. RESULTS: A systematic review published in 2000 and 12 more recent randomized clinical trials were identified. Compared with OS, LS reduced blood loss and pain, and resulted in a faster return of bowel function and earlier resumption of normal diet. Hospital stay was up to 2 days shorter after LS. No significant differences between the techniques were noted in the incidence of complications or postoperative mortality. The time required to complete LS was significantly longer (0.5-1.0 h more). No significant differences were found between the two procedures in terms of overall mortality, cancer-related mortality or disease recurrence. CONCLUSION: LS takes longer than OS but offers several short-term benefits. However, complication rates are similar for both procedures and no differences were found in long-term outcomes.

Nosocomial outbreak of Burkholderia pickettii infection due to a manufactured intravenous product used in three hospitals.

Forty-six cases of nosocomial infection caused by Burkholderia pickettii were reported between June and November 1993 in three metropolitan hospitals in Madrid. A case-control study of the outbreak was conducted to identify its cause. Seventy-four percent of the patients were males; the mean age +/- SD of the patients was 54 +/- 20 years. Sixty-five percent of the patients presented with some gastrointestinal disorder, and 80% had a peripheral catheter; 98% were treated with intravenous fluids, and 96% were treated with intravenous ranitidine. On the basis of results of a descriptive study and knowledge of the epidemiologic features of B. pickettii, a provisional causal hypothesis was formulated: intravenous ranitidine was the source of the outbreak. As a control measure, it was advised to stop treatment with this drug. On the basis of results of logistic regression and the microbiological isolation of B. pickettii in an ampule of the drug, we concluded that intravenous ranitidine was the cause of the outbreak.