[ESTIMATE OF THE INTRINSIC ERROR OF THE MEASURING INSTRUMENT OF THE LABORATORY FOR ANALYTICAL DETERMINATIONS OF THE CRITICAL PATIENT]. / Estimación del error intrínseco del instrumento de medida del laboratorio. PARA LAS DETERMINACIONES ANALÍTICAS DEL PACIENTE CRÍTICO.

Decrease blood loss associated with the analytical laboratory is a determinant of safety and quality in the preanalytical phase, in order to achieve an optimal level of care, where nurses have leading role to be responsible for the care of the critically ill patient.

Estimación del error intrínsico del instrumento de medida del laboratorio para las determinaciones analíticas del paciente crítico / Estimate of the intrinsic error of the measuring instrument of the laboratory for analytical determinations of the critical patient

Disminuir las pérdidas sanguíneas asociadas a las analíticas de laboratorio constituye un determinante de seguridad y calidad en la fase preanalítica, para llegar a alcanzar un óptimo nivel asistencial donde las enfermeras poseen gran protagonismo, al ser responsables del cuidado del paciente críticamente enfermo (AU)

Decrease blood loss associated with the analytical laboratory is a determinant of safety and quality in the preanalytical phase, in order to achieve an optimal level of care, where nurses have leading role to be responsible for the care of the critically ill patient (AU)

The incidence of cardiovascular events after hospitalization due to CAP and their association with different inflammatory markers.

BACKGROUND: Late prognosis of Community-Acquired Pneumonia (CAP) patients is related to cardiovascular events. Persistence of inflammation-related markers, defined by high circulatory levels of interleukin 6 and 10 (IL-6/IL-10), is associated with a higher post-event mortality rate for CAP patients. However, association between these markers and other components of the immune response, and the risk of cardiovascular events, has not been adequately explored. The main objectives of this study are: 1) to quantify the incidence of cardiovascular disease, in the year post-dating their hospital admittance due to CAP and, 2) to describe the distribution patterns of a wide spectrum of inflammatory markers upon admittance to and release from hospital, and to determine their relationship with the incidence of cardiovascular disease. METHODS/DESIGN: A cohort prospective study. All patients diagnosed and hospitalized with CAP will be candidates for inclusion. The study will take place in the Universitary Hospital La Princesa, Spain, during two years. Two samples of blood will be taken from each patient: the first upon admittance and the second one prior to release, in order to analyse various immune agents. The main determinants are: pro-adrenomedullin, copeptin, IL-1, IL-6, TNF-α, IL-17, IFN-γ, IL-10 and TGF-ß, E-Selectin, ICAM-1, VCAM-1 and subpopulations of peripheral T lymphocytes (T regulator, Th1 and Th17), together with other clinical and analytical variables. Follow up will start at admittance and finish a year after discharge, registering incidence of death and cardiovascular events. The main objective is to establish the predictive power of different inflammatory markers in the prognosis of CAP, in the short and long term, and their relationship with cardiovascular disease. DISCUSSION: The level of some inflammatory markers (IL-6/IL-10) has been proposed as a means to differentiate the degree of severity of CAP, but their association with cardiovascular risk is not well established. In this study we aim to define new inflammatory markers associated with cardiovascular disease that could be helpful for the prognosis of CAP patients, by describing the distribution of a wide spectrum of inflammatory mediators and analyzing their association with the incidence of cardiovascular disease and mortality one year after release from hospital.

[Effectiveness of different physical therapy in conservative treatment of plantar fasciitis: systematic review]. / Efectividad de distintas terapias físicas en el tratamiento conservador de la fascitis plantar: revisión sistemática.

BACKGROUND: Plantar fasciitis is the most common disease of non-traumatic pain in the ankle-foot. It is more common in women aged 40-70 years and diffuse progressive start the foot or ankle that gradually worsens preventing progress. The aim of this work is to determine whether different physical therapies used in the conservative treatment of plantar fasciitis of at least one month duration in adults are effective individually and / or in combination. METHODS: A systematic review databases in The Cochrane Library, Medline, Lilacs, IBECS, IME, PEDro and ENFISPO no date restriction, in Spanish and English languages. Randomized controlled trials were included of adult patients diagnosed with plantar fasciitis, intervention studies, prospective and systematic reviews. Assessment of study eligibility was developed by two reviewers independently and unblinded standardized. To classify, we used the PEDro scale critical, form of methodological quality plus a critical review of each summary and if this was not conclusive assessment of the full text. RESULTS: 32 full-text articles were reviewed. Most used techniques are the stretches and shock waves, although the best results are obtained by combining several techniques. Shock waves are effective when other techniques have failed. CONCLUSION: Physical therapies used in the various studies have proven effective to varying degrees either to reduce pain or relieve the symptoms of plantar fasciitis.

Nutritional screening; control of clinical undernutrition with analytical parameters.

OBJECTIVE: To update the system for nutritional screening. The high prevalence of nutritional unstability that causes the Clinical Undernutrition (CU), especially within the hospitals and assisted residencies, makes it necessary to use screening tools for the constant control of undernutrition to combat it during its development. CU is not so much due to a nutritional deficiency but to the illness and its treatments. However, the screening systems currently used are aimed at detecting an already established undernutrition rather than at detecting any nutritional risk that may be present. The metabolic changes of the nutritional status that have a trophopathic effect, can be easily and automatically detected in plasma, which allows to make the necessary changes in treatments that might be too aggressive, as well as to apply nutritional support according to each case. The manual screening systems can detect those somatic changes typical of undernutrition only after many days or weeks, which might be too late. Plasma albumin is a very reliable parameter for nutritional control. A lowered amount of it, due to whatever reason, is a clear sign of a possible deficit as well as of a nutritional risk suffered by the cell way before the somatic signs of undernutrition will become apparent. A fast detection of nutritional risk, anticipating undernutrition, offers prognostic abilities, which makes screening tools based on analytic parameters the most useful, ergonomic, reliable and efficient system for nutritional screening and prognosis in the clinical practice. CONCLUSION: It is necessary to update some concepts, to leave behind old myths and to choose modern screening systems that have proven to be efficient. This is the only way achieving the dream of controlling CU among ill and vulnerable patients.

Objetivo: Actualizar el cribado nutricional. La alta prevalencia del desequilibrio nutricional que genera la Desnutrición Clínica (DC), especialmente en hospitales y residencias asistidas, obliga al uso de herramientas de cribado y a controlar su evolución para combatirla sobre la marcha. La DC deriva menos de la carencia nutricional que de los efectos de la enfermedad y sus tratamientos, pero los actuales sistemas de cribado buscan más la desnutrición ya establecida que el riesgo nutricional existente. Las alteraciones metabólicas del equilibrio nutricional que constituyen la trofopatía se pueden captar en el plasma sin demoras, automáticamente, permitiendo rectificar actitudes terapéuticas demasiado agresivas o complementarlas con el adecuado soporte nutricional. Con los sistemas manuales de cribado, solo pasados días o semanas se evidenciarán, tardíamente, los cambios somáticos expresivos de esa desnutrición. La concentración de la albúmina plasmática es un parámetro muy valioso en el control nutricional. Su disminución, cualquiera que sea la causa, expresa un posible déficit pero también el riesgo nutricional a que se ve sometida la célula, antes de que la desnutrición se manifieste somáticamente. La precocidad de la detección del riesgo nutricional, anticipándose a la desnutrición y su gran capacidad pronóstica hacen de las herramientas basadas en parámetros analíticos, el procedimiento más útil, ergonómico, seguro y eficiente para el cribado y pronóstico nutricional en el entorno clínico. Conclusión: es hora de actualizar conceptos, deshacer mitos y optar por sistemas modernos de cribado eficientes, única manera de alcanzar el sueño de controlar la DC en nuestras poblaciones enfermas y frágiles.

Cribado nutricional; control de la desnutrición clínica con parámetros analíticos / Nutritional screening; control of clinical undernutrition with analytical parameters

Objetivo: Actualizar el cribado nutricional. La alta prevalencia del desequilibrio nutricional que genera la Desnutrición Clínica (DC), especialmente en hospitales y residencias asistidas, obliga al uso de herramientas de cribado y a controlar su evolución para combatirla sobre la marcha. La DC deriva menos de la carencia nutricional que de los efectos de la enfermedad y sus tratamientos, pero los actuales sistemas de cribado buscan más la desnutrición ya establecida que el riesgo nutricional existente. Las alteraciones metabólicas del equilibrio nutricional que constituyen la trofopatía se pueden captar en el plasma sin demoras, automáticamente, permitiendo rectificar actitudes terapéuticas demasiado agresivas o complementarlas con el adecuado soporte nutricional. Con los sistemas manuales de cribado, solo pasados días o semanas se evidenciarán, tardíamente, los cambios somáticos expresivos de esa desnutrición. La concentración de la albúmina plasmática es un parámetro muy valioso en el control nutricional. Su disminución, cualquiera que sea la causa, expresa un posible déficit pero también el riesgo nutricional a que se ve sometida la célula, antes de que la desnutrición se manifieste somáticamente. La precocidad de la detección del riesgo nutricional, anticipándose a la desnutrición y su gran capacidad pronóstica hacen de las herramientas basadas en parámetros analíticos, el procedimiento más útil, ergonómico, seguro y eficiente para el cribado y pronóstico nutricional en el entorno clínico. Conclusión: es hora de actualizar conceptos, deshacer mitos y optar por sistemas modernos de cribado eficientes, única manera de alcanzar el sueño de controlar la DC en nuestras poblaciones enfermas y frágiles (AU)

Objective: To update the system for nutritional screening. The high prevalence of nutritional unstability that causes the Clinical Undernutrition (CU), especially within the hospitals and assisted residencies, makes it necessary to use screening tools for the constant control of undernutrition to combat it during its development. CU is not so much due to a nutritional deficiency but to the illness and its treatments. However, the screening systems currently used are aimed at detecting an already established undernutrition rather than at detecting any nutritional risk that may be present. The metabolic changes of the nutritional status that have a trophopathic effect, can be easily and automatically detected in plasma, which allows to make the necessary changes in treatments that might be too aggressive, as well as to apply nutritional support according to each case. The manual screening systems can detect those somatic changes typical of undernutrition only after many days or weeks, which might be too late. Plasma albumin is a very reliable parameter for nutritional control. A lowered amount of it, due to whatever reason, is a clear sign of a possible deficit as well as of a nutritional risk suffered by the cell way before the somatic signs of undernutrition will become apparent. A fast detection of nutritional risk, anticipating undernutrition, offers prognostic abilities, which makes screening tools based on analytic parameters the most useful, ergonomic, reliable and efficient system for nutritional screening and prognosis in the clinical practice. Conclusion: It is necessary to update some concepts, to leave behind old myths and to choose modern screening systems that have proven to be efficient. This is the only way achieving the dream of controlling CU among ill and vulnerable patients (AU)

Efectividad de distintas terapias físicas en el tratamiento conservador de la fascitis plantar. Revisión sistemática / Effectiveness of different physical therapy in conservative treatment of plantar fasciitis. Systematic review

Fundamentos: La fascitis plantar es la afección más frecuente de dolor no traumático en el tobillo-pie. Se presenta más en mujeres entre los 40-70 años con comienzo progresivo y difuso en planta del pie o tobillo que poco a poco se agudiza impidiendo la marcha. El objetivo de este trabajo es determinar si las distintas terapias físicas utilizadas en el tratamiento conservador de la fascitis plantar de al menos un mes de evolución son efectivas individualmente y/o combinadas entre sí. Métodos: Revisión sistemática en las bases de datos The Cochrane Library Plus, Medline, Lilacs, IBECS, IME, PEDro y Enfispo sin restricción de fecha, en español e inglés. Se incluyeron ensayos clínicos controlados aleatoriamente con personas adultas diagnosticadas de fascitis plantar, estudios de intervención, prospectivos y revisiones sistemáticas. La evaluación de la elegibilidad de los estudios fue desarrollada por dos revisores de manera independiente, estandarizada y no cegada. Para clasificarlos, se utilizó la escala crítica PEDro, formulario de calidad metodológica y una revisión crítica de cada resumen y si esto no fue concluyente evaluación del texto completo. Resultados: Se revisó un total de 32 artículos a texto completo. Las técnicas más empleadas fueron los estiramientos y las ondas de choque, aunque los mejores resultados se obtuvieron combinando varias técnicas. Las ondas de choque fueron efectivas cuando otras técnicas fracasaron. Conclusiones: Las terapias físicas empleadas en los distintos estudios han demostrado ser eficaces aunque en distinta medida ya sea para disminuir el dolor o aliviar los síntomas de la fascitis plantar (AU)

Background: Plantar fasciitis is the most common disease of non-traumatic pain in the ankle-foot. It is more common in women aged 40-70 years and diffuse progressive start the foot or ankle that gradually worsens preventing progress. The aim of this work is to determine whether different physical therapies used in the conservative treatment of plantar fasciitis of at least one month duration in adults are effective individually and / or in combination. Methods: A systematic review databases in The Cochrane Library, Medline, Lilacs, IBECS, IME, PEDro and ENFISPO no date restriction, in Spanish and English languages. Randomized controlled trials were included of adult patients diagnosed with plantar fasciitis, intervention studies, prospective and systematic reviews. Assessment of study eligibility was developed by two reviewers independently and unblinded standardized. To classify, we used the PEDro scale critical, form of methodological quality plus a critical review of each summary and if this was not conclusive assessment of the full text. Results: 32 full-text articles were reviewed. Most used techniques are the stretches and shock waves, although the best results are obtained by combining several techniques. Shock waves are effective when other techniques have failed. Conclusion: Physical therapies used in the various studies have proven effective to varying degrees either to reduce pain or relieve the symptoms of plantar fasciitis (AU)

Fiabilidad de los resultados analíticos de muestra sanguínea desechando el doble del espacio muerto del catéter / Reliability of laboratory findings from blood samples when only the double dead space in catheter is discarded

OOBJETIVO: determinar la fiabilidad de dos métodos de extracción desangre a través de catéter arterial en los pacientes ingresados en una unidad de reanimación postquirúrgica. MATERIAL Y MÉTODO: estudio cuasi experimental realizado en el Hospital de la Princesa de Madrid, de febrero a mayo de 2010, en el que se compararon dos métodos de extracción de muestra de sangre para análisis a través de catéter arterial periférico, realizados secuencialmente: primero la intervención= 2 cc sangre desechada + 13,5 muestra a analizar, y segundo el control= inmediatamente después de la extracción previa= 15,5 cc + 13,5 muestra a analizar, en relación a los resultados de parámetros analíticos bioquímicos, hematológicos y de coagulación. RESULTADOS: la diferencia de las medias es muy pequeña en todos los parámetros estudiados; en todos los casos el "0" se encuentra incluido en los respectivos intervalos de confianza, no siendo estadísticamente significativos (p> 0,05). Las correlaciones son superiores a 0,93 en todos los parámetros estudiados en el caso de la bioquímica, superiores a0,84 en el caso de la hematimetría y superiores a 0,90 en el caso de la coagulación, obteniendo en todos los casos unos valores de p< de 0,05.CONCLUSIONES: para garantizar la calidad de los resultados de laboratorio es suficiente desechar el volumen correspondiente al doble del espacio muerto del sistema (en el presente estudio 2 cc)

PURPOSE: to assess reliability of two blood sample drawing methods though an arterial catheter in patients admitted to a postoperative resuscitation unit. MATERIAL AND METHODS: a quasi-experimental study was carried out at Hospital de la Princesa, Madrid, Spain, from February to May 2010.Two sequentially used methods for drawing blood samples for laboratory tests through a peripheral arterial catheter were compared: firstly the intervention procedure = 2 cc of blood discarded + a 13.5 sample for laboratory testing; and secondly the control procedure = immediately after previous sample drawing = 15.5 cc + a 13.5 sample for laboratory testing. Biochemistry, hematology and coagulation laboratory parameters were compared. RESULTS: differences in mean values were very low for all assessed parameters. Zero value is always included in confidence intervals; therefore, differences were not statistically significant (p > 0.05). Correlation is higher than 0.93 for all assessed biochemistry parameters, higher than 0.84 for hematology parameters, and higher than 0.90 for coagulation parameters (p < 0.05 for all comparisons).CONCLUSIONS: discarding the volume corresponding to the doubledead space in the system (2 cc in our study) is adequate to ensure quality in laboratory testing results