Use of Nursing Concepts in Program and Course Descriptions: An Analysis of Prelicensure Baccalaureate Nursing Programs in the United States.

BACKGROUND: Ongoing discussions address how and when to introduce nursing concepts in nursing education. PURPOSE: To examine whether baccalaureate nursing programs use 4 nursing concepts in their program and course descriptions. METHODS: Researchers explored websites of 300 US bachelor of science in nursing (BSN) programs and assigned scores based on how many of 4 nursing concepts (context, holism, health, and caring) were represented in program and 3 course descriptions. RESULTS: Mean program and course scores were 2.51, 0.96, 1.17, and 1.18, respectively. Programs and courses included between 0 and 4 concepts in their descriptions. There was a significant difference in program scores between BSN programs in 4 US regions. The most frequently identified concept was "context" in program descriptions and "holism" in course descriptions. CONCLUSIONS: Discipline-specific concepts are missing in many baccalaureate programs and course descriptions, which raises questions about how and when nursing students are learning what nursing is.

Cirugía de los tumores neurales del sacro / Surgery of neurogenic tumors of the sacrum

Nuestro objetivo es compartir nuestra experiencia en tumores neurogénicos del área sacra, una patología infrecuente, valorando las vías de abordaje, técnicas intraoperatorias, complicaciones y evolución de los pacientes en una serie de casos. Métodos: Realizamos un análisis retrospectivo de 19 casos de tumores neurogénicos de la región sacra diagnosticados y operados en nuestro centro, de los cuales ocho eran hombres y 11 mujeres, registrando una edad media al diagnóstico de 51 años (con un rango de edades entre 25 y 78 años). Seis se encontraban asintomáticos y fueron diagnosticados incidentalmente, mientras que la mayoría (11 pacientes) presentaban dolor lumbar acompañado de otros síntomas: dolor irradiado a miembros inferiores (MMII), dolor pélvico, alteraciones sensitivas y pérdida de fuerza en MMII. Dos pacientes presentaban otro síntoma principal al diagnóstico: dolor pélvico y en miembro inferior izquierdo (MII). A todos los pacientes se les realizó como mínimo una prueba de imagen (RM/TC). Nueve pacientes tenían tumores limitados al sacro o con extensión posterior, practicándose una intervención por vía posterior. En seis se realizó un abordaje exclusivamente por vía anterior debido a la localización presacra de la tumoración; y en cuatro de ellos fue preciso un abordaje tanto anterior como posterior. Resultados: Los seis pacientes asintomáticos al diagnóstico continuaron sin síntomas tras la intervención. En ocho desaparecieron los síntomas después de la cirugía, y al alta cuatro presentaron dolor lumbar o de miembros que mejoró en consultas sucesivas. Una paciente presentó clínica consistente en déficit motor y sensitivo en el miembro inferior derecho derivada de la afectación del nervio ciático poplíteo externo. El tiempo medio de seguimiento fue de 69 meses (desde seis hasta 178 meses) (AU)

Our objective is to share our experience in neurogenic tumors of the sacral area, an uncommon disease, and assess approaches, intraoperative techniques, complications and clinical course of patients in a case series. Methods: We conducted a retrospective analysis of 19 cases of patients with neurogenic tumors in the sacral area who were diagnosed and underwent surgery at our center. Of them, 8 were male and 11 were female. They had a mean age at diagnosis of 51 years (with an age range of 25-78 years). Six patients were asymptomatic and were diagnosed incidentally, while the majority (11 patients) presented with lumbar pain accompanied by other symptoms: pain radiating to the legs, pelvic pain, sensory alterations and loss of strength in the legs. Two patients presented with another primary symptom on diagnosis: pain in the pelvic region and in the left leg. All patients underwent a least one imaging test (MRI/CT scan). Nine patients had tumors limited to the sacrum or with subsequent spread, with surgery via the posterior route. In 6 cases, an exclusively anterior approach was employed owing to the pre-sacral location of the tumor; 4 cases required both an anterior and posterior approach. Results: The 6 patients who were asymptomatic at diagnosis continued to have no symptoms after surgery. In 8 patients, symptoms resolved after surgery, and at discharge 4 had pain in the lumbar region or legs, which improved in subsequent consultations. One patient had symptoms consistent with motor and sensory deficit in the right leg deriving from impairment of the external popliteal sciatic nerve. The mean follow-up period was 69 months (6-178 months) (AU)

Traction-induced aneurysm of an accessory left hepatic artery: a potentially fatal but synchronously treatable complication of a large hiatus hernia.

A 59-year-old man presented to our surgical clinic with a long-standing history of heart burn, and upper abdominal pain. Gastroscopy showed a large sliding hiatus hernia associated with severe reflux oesophagitis. Oesophageal pH manometry revealed a high DeMeester score of 36.03. A computed tomography (CT) scan was performed for preoperative hiatal hernia repair planning. This showed the incidental finding of an accessory left hepatic artery (ALHA) and an aneurysm of this accessory artery. The aneurysm occurred at the point where the ALHA traversed the diaphragmatic crus and was only present in association with the hiatus hernia. These observations suggest that the aetiology of the aneurysm was due to traction during development of the hiatus hernia. The patient went onto have a laparoscopic hiatus hernia repair and Toupet fundoplication with ligation of the accessory left hepatic artery and made an excellent recovery. ALHAs are not uncommon, occurring in around 15% of the general population, with aneurysms of the hepatic arteries accounting for about 20% of cases of visceral artery aneurysms. The case presented herein highlights the importance of performing an arterial phase CT when planning surgery for large hiatus hernias to detect more cases like this one. This would allow early detection and concurrent treatment of an associated aneurysm with repair of the hiatus hernia, to prevent aneurysmal complications later on.

[Non-functioning pituitary adenomas: epidemiology, clinical and postoperative outcome]. / Adenomas hipofisarios no funcionantes: epidemiología, clínica y evolución posquirúrgica.

INTRODUCTION: Non-functioning pituitary adenomas are the most frequent tumor group in the sellar region. They are usually benign neoplasms diagnosed after visual or hormonal symptoms, although it is not uncommon to detect them as a casual finding. AIM: To analyze the clinical aspects found in this disease and its response after surgical treatment. PATIENTS AND METHODS: In a series of 100 cases, epidemiological, clinical, endocrinological, visual and radiological data were analyzed before and after surgical treatment, as well as the complications related to surgery and long-term follow-up. RESULTS: The most frequent symptom at the time of diagnosis was visual field involvement (62%), and only the 7% of adenomas were a casual finding. The most common hormonal deficit was hypogonadotropic hypogonadism (48%). After surgery, complete recovery of the visual field defect was observed in 54.8% of the patients, only 1% worsening after surgery, and the incidence of diabetes insipidus was 4%. The resection was superior to 95% in 63% of cases, although the percentage of adenomas with invasion of the cavernous sinus in Knosp grades 3 and 4 it was high (45%). CONCLUSIONS: Although the most frequent symptom of non-functioning pituitary adenomas is campimetric involvement, it has an excellent response to surgery if it is performed within the appropriate time. The grade of invasion of the cavernous sinus is the most limiting factor for a complete surgical resection.

TITLE: Adenomas hipofisarios no funcionantes: epidemiología, clínica y evolución posquirúrgica.Introducción. Los adenomas hipofisarios no funcionantes son el grupo tumoral más frecuente en la región selar. Suelen ser neoplasias benignas diagnosticadas por síntomas visuales u hormonales, aunque no es infrecuente detectarlos como un hallazgo casual. Objetivo. Analizar los aspectos clínicos hallados en esta enfermedad y su respuesta tras el tratamiento quirúrgico. Pacientes y métodos. En una serie de 100 casos, se analizaron datos epidemiológicos, clínicos, endocrinológicos, visuales y radiológicos antes y después del tratamiento quirúrgico, y se recogen las complicaciones relacionadas con la cirugía y el seguimiento a largo plazo. Resultados. El síntoma más frecuente en el momento del diagnóstico fue la afectación del campo visual (62%), y sólo el 7% de los adenomas se trataba de un hallazgo casual. El déficit hormonal más frecuente era el hipogonadismo hipogonadótropo (48%). Tras la cirugía se observó recuperación completa del defecto campimétrico en el 54,8% de los pacientes, con sólo un 1% de empeoramiento tras la cirugía, y la incidencia de diabetes insípida fue del 4%. La resección fue superior al 95% en el 63% de los casos, a pesar de que el porcentaje de adenomas con invasión del seno cavernoso en grados altos fue elevado (45%). Conclusiones. Aunque el síntoma más frecuente de los adenomas hipofisarios no funcionantes es la afectación campimétrica, ésta tiene una excelente respuesta a la cirugía si se realiza dentro del tiempo adecuado. El grado de invasión del seno cavernoso parece el factor más limitante para una resección quirúrgica completa.

Siringomielia no secundaria a Chiari. Actualización en fisiopatología y manejo / Update on the pathophysiology and management of syringomyelia unrelated to Chiari malformation

Introducción: Son muchos los conocimientos y publicaciones existentes sobre la siringomielia relacionada con la malformación de Chiari, pero existe poca difusión de este cuadro cuando no se presenta en relación con dicha malformación. Ello es importante ya que es una entidad propia que precisa de un conocimiento y manejo específico. Presentamos esta revisión con el objetivo de dar a conocer las ideas más aceptadas y difundidas a día de hoy al respecto de la fisiopatología, manejo y otros aspectos de la siringomielia no secundaria a malformación de Chiari. Desarrollo: Se ha realizado una revisión de la literatura más relevante en torno a esta patología, centrándose en su fisiopatología, presentación clínica, estudio diagnóstico y manejo. Conclusiones: La siringomielia no relacionada con malformación de Chiari es una entidad propia que precisa de un conocimiento adecuado en su profundidad para su sospecha, seguimiento y manejo adecuado. Ante el hallazgo de este cuadro debe realizarse un estudio detallado encaminado a intentar identificar la causa, quedando el tratamiento sintomático como opción de rescate

Introduction: Much has been published on syringomyelia related to Chiari malformation. In contrast, little is known about the condition when it is not associated with this malformation, but this presentation of syringomyelia constitutes a different entity and therefore requires specific management. We conducted a literature review to summarise the most accepted and widespread ideas about the pathophysiology, management and other aspects of syringomyelia unrelated to Chiari malformation. Development: We reviewed the most relevant literature on this condition, focusing on the pathophysiology, clinical presentation, diagnosis, and treatment. Conclusions: Syringomyelia unrelated to Chiari malformation is a distinct entity that must be well understood to guarantee correct diagnosis, monitoring, and management. When the disease is suspected, a thorough study should be conducted to identify its aetiology. Treatment must aim to eliminate the cause of the disease; symptomatic treatment should remain a second-line option

Infecciones relacionadas con la asistencia sanitaria en pacientes ingresados en un servicio de Urología: patrones de resistencia y adecuación del tratamiento antibiótico empírico como factor pronóstico / Infections related to healthcare in patients hospitalized in a Urology service: Resistance patterns and adequacy of empirical antibiotic treatment as a prognostic factor

Objetivos: Evaluar la idoneidad de la antibioterapia empírica en IRAS y los patrones de resistencia a antibióticos de los microorganismos responsables, así como la incidencia de mortalidad y factores de riesgo en relación con IRAS. Método: Durante un periodo de 4 años se realiza un estudio prospectivo observacional sobre todos los pacientes de ambos sexos y mayores de 16 años ingresados por cualquier proceso urológico. Se evalúan la incidencia y las características de las IRAS y se analiza el microorganismo causante y sus resistencias, la antibioterapia empírica inicial y si esta precisó modificación, y las tasas de mortalidad. Resultados: De un total de 6.546 pacientes, el 6,3% sufrieron IRAS, correspondiendo el 70,5% a infección del tracto urinario y el 22,1% a infección de la herida quirúrgica. E. coli, Enterococcus spp., Klebsiella spp. y P. aeruginosa fueron los más frecuentemente implicados (25,1, 17,5, 13,5 y 12,3%, respectivamente). E. coli y Klebsiella spp. fueron productoras de betalactamasas de espectro extendido (BLEE) en el 24,7 y el 47,8%, respectivamente. El 4,3% de Klebsiella y el 33,3% de Pseudomonas eran resistentes a carbapenemes. La resistencia global a quinolonas fue del 50% aproximadamente. Los antibióticos más frecuentemente usados de forma empírica fueron cefalosporinas de tercera y cuarta generación (33,6%) y carbapenemes (28,2%). Se obtuvo una tasa global de adecuación de antibioterapia empírica del 82,9%. La tasa de mortalidad en los pacientes con IRAS fue del 2,2%, frente al 0,3% en los pacientes sin infección. En un análisis multivariable, las variables que se asociaron a mayor riesgo de mortalidad fueron el aislamiento de enterobacterias productoras de BLEE y el tratamiento antibiótico empírico inadecuado. Conclusiones: La selección de la antibioterapia empírica fue bastante precisa. Se está observando un aumento de IRAS por microorganismos multirresistentes, como enterobacterias BLEE o P.aeruginosa multirresistentes. El riesgo de mortalidad aumenta con una antibioterapia empírica inicial inadecuada o cuando el microorganismo responsable es una enterobacteria BLEE

Objectives: To evaluate the suitability of empirical antibiotic therapy in HAIs and the antibiotic resistance patterns of the responsible microorganisms, as well as the incidence of mortality and risk factors involved. Method: A prospective observational study was carried out on patients of both sexes older than 16 years, admitted by any urological process during a period of 4 years. The incidence and characteristics of HAIs, as well as the causative organism and its resistance, the initial empirical antibiotic therapy and its modification, if required, and mortality rates are analyzed. Results: Out of 6546 patients, 6.3% suffered HAIs, 70.5% corresponding to urinary tract infection and 22.1% to infection of the surgical wound. E.coli, Enterococcus spp., Klebsiella spp. y P. aeruginosa were the most frequently implicated (25.1%, 17.5%, 13.5% and 12.3%, respectively). E. coli and Klebsiella spp. were producers of extended-spectrum beta-lactamases (ESBL) in 24.7% and 47.8%, respectively. 4.3% of Klebsiella and 33.3% of Pseudomonas were carbapenems-resistant. The overall resistance to quinolones was approximately 50%. The most commonly used antibiotics for empirical therapy were cephalosporins of 3rd and 4th generation (33.6%) and carbapenems (28.2%). An overall rate of adequacy of empirical antibiotic therapy of 82.9% was obtained. The mortality rate in patients with HAIs was 2.2%, compared with 0.3% in patients without infection. In a multivariate analysis, the variables associated with the highest mortality risk were the isolation of ESBL-producing enterobacteria and the inadequate empirical antibiotic treatment. Conclusions: The selection of empirical antibiotic therapy was quite accurate. An increase in HAIs by multiresistant microorganisms, such as ESBL Enterobacteria or multiresistant P.aeruginosa is being observed. The mortality risk increases with inadequate initial empirical antibiotic therapy or when the responsible microorganism is an ESBL enterobacteria

Application of pharmacokinetic/pharmacodynamic analysis to evaluate the adequacy of antimicrobial therapy for pediatric acute otitis media in Spain before and after the introduction of the PCV7 vaccine.

OBJECTIVE: To evaluate, by applying pharmacokinetic/pharmacodynamic (PK/PD) analysis, if the change in antibiotic susceptibility after the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in Spain had any influence on the usefulness of the antimicrobials more frequently used as empirical treatment of pediatric acute otitis media (AOM). METHODS: PK parameters and susceptibility of Streptococcus pneumoniae and Haemophilus influenzae were obtained from bibliography. Monte Carlo simulation was used to estimate the cumulative fraction of response (CFR), understood as the expected probability of therapy success. For amoxicillin and amoxicillin/clavulanate, the target was free antibiotic concentration remaining above the minimum inhibitory concentration (MIC) for ≥50% of the dosing interval (fT>MIC≥50%), whereas for cefuroxime axetil and cefotaxime, the target was fT>MIC≥60%. CFR values ≥90% were considered successful. RESULTS: When all serotypes of S. pneumoniae are considered, amoxicillin and cefotaxime turned out to reach a high probability of success, and difference before and after vaccination was scarce. For H. influenzae, CFR values were higher with amoxicillin/clavulanate than with amoxicillin. For both microorganisms, cefuroxime axetil resulted in low probability of success in the two periods of study. CONCLUSIONS: We have shown that the introduction of the PCV7 vaccination did not lead to changes in the probability of success of the current empiric treatments of the AOM. Integrated PK/PD analysis has demonstrated to be a useful tool to identify changes in antimicrobial activity after the implantation of a vaccination program, providing complementary information to the simple assessment of MIC values.

Infections related to healthcare in patients hospitalized in a Urology service: resistance patterns and adequacy of empirical antibiotic treatment as a prognostic factor. / Infecciones relacionadas con la asistencia sanitaria en pacientes ingresados en un servicio de Urología: patrones de resistencia y adecuación del tratamiento antibiótico empírico como factor pronóstico.

OBJECTIVES: To evaluate the suitability of empirical antibiotic therapy in HAIs and the antibiotic resistance patterns of the responsible microorganisms, as well as the incidence of mortality and risk factors involved. METHOD: A prospective observational study was carried out on patients of both sexes older than 16years, admitted by any urological process during a period of 4years. The incidence and characteristics of HAIs, as well as the causative organism and its resistance, the initial empirical antibiotic therapy and its modification, if required, and mortality rates are analysed. RESULTS: Out of 6,546 patients, 6.3% suffered HAIs, 70.5% corresponding to urinary tract infection and 22.1% to infection of the surgical wound. E.coli, Enterococcus spp., Klebsiella spp. y P.aeruginosa were the most frequently implicated (25.1%, 17.5%, 13.5% and 12.3%, respectively). E.coli and Klebsiella spp. were producers of extended-spectrum beta-lactamases (ESBL) in 24.7% and 47.8%, respectively. 4.3% of Klebsiella and 33.3% of Pseudomonas were carbapenems-resistant. The overall resistance to quinolones was approximately 50%. The most commonly used antibiotics for empirical therapy were cephalosporins of 3rd and 4th generation (33.6%) and carbapenems (28.2%). An overall rate of adequacy of empirical antibiotic therapy of 82.9% was obtained. The mortality rate in patients with HAIs was 2.2%, compared with 0.3% in patients without infection. In a multivariate analysis, the variables associated with the highest mortality risk were the isolation of ESBL-producing enterobacteria and the inadequate empirical antibiotic treatment. CONCLUSIONS: The selection of empirical antibiotic therapy was quite accurate. An increase in HAIs by multiresistant microorganisms, such as ESBL Enterobacteria or multiresistant P.aeruginosa is being observed. The mortality risk increases with inadequate initial empirical antibiotic therapy or when the responsible microorganism is an ESBL enterobacteria.

Update on the pathophysiology and management of syringomyelia unrelated to Chiari malformation. / Siringomielia no secundaria a Chiari. Actualización en fisiopatología y manejo.

INTRODUCTION: Much has been published on syringomyelia related to Chiari malformation. In contrast, little is known about the condition when it is not associated with this malformation, but this presentation of syringomyelia constitutes a different entity and therefore requires specific management. We conducted a literature review to summarise the most accepted and widespread ideas about the pathophysiology, management and other aspects of syringomyelia unrelated to Chiari malformation. DEVELOPMENT: We reviewed the most relevant literature on this condition, focusing on the pathophysiology, clinical presentation, diagnosis, and treatment. CONCLUSIONS: Syringomyelia unrelated to Chiari malformation is a distinct entity that must be well understood to guarantee correct diagnosis, monitoring, and management. When the disease is suspected, a thorough study should be conducted to identify its aetiology. Treatment must aim to eliminate the cause of the disease; symptomatic treatment should remain a second-line option.

Infecciones por enterobacterias productoras de carbapenemasas en un servicio de urología. Un nuevo desafío / Infections by carbapenemase-producing enterobacteriaceae in a department of urology. A new challenge

Objetivos: Analizar las infecciones por enterobacterias productoras de carbapenemasas (EPC) y describir características y posibles factores de riesgo asociados con los pacientes de un servicio de urología. Material y métodos: Estudio observacional y retrospectivo. El criterio de inclusión fue haber estado ingresado en nuestro servicio de urología entre agosto de 2013 y diciembre de 2016. Se analizaron aquellos que presentaron positividad para EPC en al menos un cultivo. Se revisaron características basales y factores de riesgo. Asimismo se revisaron variables como presencia de infecciones urinarias previas, reingresos posteriores, el microorganismo, tipo de EPC, tratamiento administrado, un origen hospitalario o comunitario y la mortalidad. Resultados: De los 5.657 pacientes que cumplían criterio de inclusión, en 12 casos se aisló una EPC. Las infecciones por EPC representaron un 3,6% del total de infecciones relacionadas con la asistencia sanitaria y un 9,7% de las producidas por enterobacterias. Los factores analizados asociados a infección por EPC en nuestra serie son: presencia de catéteres urinarios (100%), haber sido sometido a tratamiento quirúrgico (58,3%), ingreso previo en UCI (8,3%) e inmunosupresión (16,6%). Con relación a la mortalidad, un 8,3% de los pacientes que presentaron infección por EPC fallecieron durante el ingreso. Conclusiones: Aproximadamente un 10% de las enterobacterias presenta patrón de resistencia a carbapenemasas en el paciente urológico de nuestro medio. Ser portador de catéter urinario y/o someterse a una cirugía son factores de riesgo asociados al desarrollo de estas infecciones en el paciente urológico de nuestro medio. La infección por una EPC eleva la morbimortalidad

Objectives: To analyse infections by carbapenemase-producing enterobacteriaceae (CPE) and describe the characteristics and potential risk factors associated with patients of a department of urology. Material and methods: Observational and retrospective study. The inclusion criterion was hospitalisation in our department of Urology between August 2013 and December 2016. We analysed those patients who were positive for CPE in at least 1 culture. We reviewed their baseline characteristics, risk factors and variables such as the presence of previous urinary tract infections, subsequent readmissions, the microorganism, type of CPE, treatment, origin (hospital or community) and mortality. Results: Of the 5,657 patients who met the inclusion criterion, a CPE was isolated in 12 cases. CPE infections represented 3.6% of all healthcare-associated infections and 9.7% of those caused by enterobacteria. The analysed factors associated with CPE infection in our series were the presence of urinary catheters (100%), undergoing surgery (58.3%), previous ICU admission (8.3%) and immunosuppression (16.6%). In terms of mortality, 8.3% of the patients who presented CPE infection died during hospitalisation. Conclusions: Approximately 10% of enterobacteria present a carbapenemase-resistance pattern in urological patients in our setting. Carrying a urinary catheter and/or undergoing surgery are risk factors associated with the development of these infections in urological patients in our setting. CPE infections increase morbidity and mortality

Population pharmacokinetics of daptomycin in critically ill patients.

Daptomycin has shown activity against a wide range of Gram-positive bacteria; however, the approved dosages usually seem insufficient for critically ill patients. The aim of this study was to develop a population pharmacokinetic model for daptomycin in critically ill patients and to estimate the success of the therapy by applying pharmacokinetic/pharmacodynamic (PK/PD) criteria. Sixteen intensive care unit patients were included, four of whom underwent continuous renal replacement therapies (CRRT). Blood and, when necessary, effluent samples were drawn after daptomycin administration at previously defined time points. A population approach using NONMEM 7.3 was performed to analyse data. Monte Carlo simulations were executed to evaluate the suitability of different dosage regimens. The probabilities of achieving the PK/PD target value associated with treatment success (ratio of the area under the plasma concentration-time curve over 24 h divided by the minimum inhibitory concentration (AUC24/MIC ≥ 666)) and to reach daptomycin concentrations linked to toxicity (minimum concentration at steady-state (Cminss) ≥ 24.3 mg/L) were calculated. The pharmacokinetics of daptomycin was best described by a one-compartment model. Elimination was conditioned by the creatinine clearance (Clcr) and also by the extra-corporeal clearance when patients were subjected to continuous renal replacement therapy (CRRT). The PK/PD analysis confirmed that 280- and 420-mg/d dosages would not be enough to achieve high probabilities of target attainment for MIC values ≥ 1 mg/L in patients with Clcr ≥ 60 mL/min or in subjects with lower Clcrs but receiving CRRT. In these patients, higher dosages (560-840 mg/d) should be needed. When treating infections due to MIC values ≥ 4 mg/L, even the highest dose would be insufficient.

Infections by carbapenemase-producing enterobacteriaceae in a department of urology. A new challenge. / Infecciones por enterobacterias productoras de carbapenemasas en un servicio de urología. Un nuevo desafío.

OBJECTIVES: To analyse infections by carbapenemase-producing enterobacteriaceae (CPE) and describe the characteristics and potential risk factors associated with patients of a department of urology. MATERIAL AND METHODS: Observational and retrospective study. The inclusion criterion was hospitalisation in our department of Urology between August 2013 and December 2016. We analysed those patients who were positive for CPE in at least 1 culture. We reviewed their baseline characteristics, risk factors and variables such as the presence of previous urinary tract infections, subsequent readmissions, the microorganism, type of CPE, treatment, origin (hospital or community) and mortality. RESULTS: Of the 5,657 patients who met the inclusion criterion, a CPE was isolated in 12 cases. CPE infections represented 3.6% of all healthcare-associated infections and 9.7% of those caused by enterobacteria. The analysed factors associated with CPE infection in our series were the presence of urinary catheters (100%), undergoing surgery (58.3%), previous ICU admission (8.3%) and immunosuppression (16.6%). In terms of mortality, 8.3% of the patients who presented CPE infection died during hospitalisation. CONCLUSIONS: Approximately 10% of enterobacteria present a carbapenemase-resistance pattern in urological patients in our setting. Carrying a urinary catheter and/or undergoing surgery are risk factors associated with the development of these infections in urological patients in our setting. CPE infections increase morbidity and mortality.

Tratamiento adyuvante intravesical en cáncer de vejiga no músculo invasivo: importancia de la cepa y el mantenimiento / Adjuvant intravesical treatment for nonmuscle invasive bladder cancer: The importance of the strain and maintenance

Introducción y objetivo: El bacilo de Calmette-Guérin (BCG) intravesical es clave en la prevención de recurrencia y progresión de tumor vesical superficial. El objetivo de nuestro trabajo es evaluar comparativamente la eficacia y toxicidad entre Connaught y Tice, así como la importancia del esquema de mantenimiento. Material y métodos: Revisamos retrospectivamente a 110 pacientes con tumor vesical superficial con tratamiento endovesical adyuvante, distribuidos en 3 grupos, según el tratamiento fuese con Connaught, Tice, o ambos secuencialmente. Se ha calculado la supervivencia libre de recidiva en cada grupo y también de los pacientes que completaron el mantenimiento frente a los que no lo hicieron. Para identificar factores predictores de recidiva se llevó a cabo un análisis multivariante. Además, se ha valorado la toxicidad analizando la aparición de becegeítis, urgencia miccional, fiebre, infección urinaria y abandono del tratamiento por los efectos secundarios. Resultados: No hallamos diferencias en los parámetros de eficacia. Los pacientes del grupo Connaught completaron en menor medida el mantenimiento (38,4 frente a 72% del grupo Tice y frente a 76,3% del grupo ambas; p = 0,010). Los pacientes que completaron el mantenimiento tuvieron mejor supervivencia libre de recidiva a 60 meses (88,5 vs. 74,2%; p = 0,036), independientemente de la cepa empleada. El análisis multivariante identificó como factores de riesgo de recidiva el tamaño mayor de 3 cm, más de 3 implantes y no completar el mantenimiento. Los pacientes de Connaught experimentan mayor tasa de becegeítis, sin diferencias en el resto de los eventos estudiados. Conclusión: Completar la fase de mantenimiento es esencial, independientemente de la cepa empleada. Connaught tiene más riesgo de becegeítis y un esquema secuencial puede ser útil en ciertos escenarios

Background and objective: Intravesical Bacille Calmette-Guérin (BCG) is essential for preventing the recurrence and progression of superficial bladder tumours. The aim of our study was to compare the efficacy and toxicity of the Connaught and Tice strains, as well as the importance of the maintenance regimen. Material and methods: We retrospectively reviewed 110 patients with superficial bladder tumours who underwent adjuvant endovesical treatment. The patients were distributed into 3 groups, based on whether the treatment was with the Connaught strain, the Tice strain or both sequentially. We calculated the relapse-free survival rate in each group and compared the patients who completed the maintenance treatments against those who did not. To identify the predictors of relapse, we performed a multivariate analysis. We also assessed the toxicity by analysing the onset of BCGitis, urinary urgency, fever, urinary tract infection and treatment withdrawing due to adverse effects. Results: We found no differences in the efficacy parameters. The patients in the Connaught group completed the maintenance to a lesser extent (38.4 vs. 72% for the Tice group and 76.3% for both groups; P=.010). The patients who completed the maintenance had better relapse-free survival at 60 months (88.5 vs. 74.2%; P=.036), regardless of the strain employed. The multivariate analysis identified a size larger than 3 cm, more than 3 implants and not completing the maintenance as risk factors of relapse. The patients with the Connaught strain had higher rates of BCGitis, with no differences in the other events studied. Conclusion: Completing the maintenance phase is essential, regardless of the strain employed. The Connaught strain has a greater risk of BCGitis, and a sequential regimen could be useful in certain scenarios

Hiccups in Parkinson's disease: an analysis of cases reported in the European pharmacovigilance database and a review of the literature.

BACKGROUND: Some reports have suggested an association between dopamine agonists and hiccups, involuntary contractions that merit full clinical attention because they can be very debilitating. Many drugs frequently used to treat hiccups are formally contraindicated in Parkinson's disease due to their liability to worsen motor symptoms, making the treatment of hiccups problematic in this disease. The objective of the present study was to analyze all spontaneous reports of hiccups from the European Pharmacovigilance Database in patients with Parkinson's disease and/or on dopaminergic drugs. Finally, we sought to identify evidence-based recommendations on the management of hiccups in Parkinson's disease. METHODS: We searched for all reports of hiccups in the European Pharmacovigilance Database (EudraVigilance) and calculated proportional reporting ratios for dopamine agonists and hiccups. We reviewed the literature on Parkinson's disease, dopamine agonists, and hiccups, searching for specific treatment recommendations for hiccups in this disease. RESULTS: Both rotigotine and pramipexole fulfilled the criteria to generate a safety signal. We found 32 and 13 cases of hiccups associated with dopamine agonists in EudraVigilance and the literature, respectively. There were no specific recommendations for the management of hiccups in Parkinson's disease in the clinical guidelines consulted. CONCLUSIONS: We have found evidence that rotigotine and pramipexole are associated with the appearance of hiccups and that this adverse reaction occurs predominantly in males. Given the scarce information available, specific recommendations are needed in clinical guidelines for the adequate management of hiccups in Parkinson's disease.

Adjuvant intravesical treatment for nonmuscle invasive bladder cancer: The importance of the strain and maintenance. / Tratamiento adyuvante intravesical en cáncer de vejiga no músculo invasivo: importancia de la cepa y el mantenimiento.

BACKGROUND AND OBJECTIVE: Intravesical Bacille Calmette-Guérin (BCG) is essential for preventing the recurrence and progression of superficial bladder tumours. The aim of our study was to compare the efficacy and toxicity of the Connaught and Tice strains, as well as the importance of the maintenance regimen. MATERIAL AND METHODS: We retrospectively reviewed 110 patients with superficial bladder tumours who underwent adjuvant endovesical treatment. The patients were distributed into 3 groups, based on whether the treatment was with the Connaught strain, the Tice strain or both sequentially. We calculated the relapse-free survival rate in each group and compared the patients who completed the maintenance treatments against those who did not. To identify the predictors of relapse, we performed a multivariate analysis. We also assessed the toxicity by analysing the onset of BCGitis, urinary urgency, fever, urinary tract infection and treatment withdrawing due to adverse effects. RESULTS: We found no differences in the efficacy parameters. The patients in the Connaught group completed the maintenance to a lesser extent (38.4 vs. 72% for the Tice group and 76.3% for both groups; P=.010). The patients who completed the maintenance had better relapse-free survival at 60 months (88.5 vs. 74.2%; P=.036), regardless of the strain employed. The multivariate analysis identified a size larger than 3cm, more than 3 implants and not completing the maintenance as risk factors of relapse. The patients with the Connaught strain had higher rates of BCGitis, with no differences in the other events studied. CONCLUSION: Completing the maintenance phase is essential, regardless of the strain employed. The Connaught strain has a greater risk of BCGitis, and a sequential regimen could be useful in certain scenarios.