Implementation of a vascular access team and an intravenous therapy programme: A first-year activity analysis.

BACKGROUND: Creating Vascular Access Teams (VAT) provides an expert nursing role that contributes to the training and continuous improvement of healthcare personnel. They can offer greater clinical safety, reducing complications and costs. Peripherally inserted central catheters (PICCs) and midline catheters (ML) can be safe and cost-effective alternatives to other types of venous access (VA). The aim of the study was to analyse our centre's VAT first 12 months of activity. The primary outcome was reported complications. Secondary outcomes were cause of catheter removal, consultancy activity and economic impact of VAT implantation. METHODOLOGY: A longitudinal, descriptive study was carried out from March 2019 to March 2020. Using consecutive sampling, all VA inserted, and all consults received were included. Patients under 18 years of age were excluded. RESULTS: The VAT inserted 1257 catheters into 1056 patients (291 MLs, 966 PICCs). The mean dwell time was 14.9 days for MLs and 59.07 days for PICCs. The main reason for removing VA was end of treatment (80.7%). During VA follow-up confirmed infection was detected in 1 ML (0.3%) and nine PICCs (0.9%). Symptomatic thrombosis was reported in 2 MLs (0.7%) and 16 PICCs (1.7%). The VAT received 367 consultations, and the main reason for consultation was to resolve doubts regarding the management of VA (80.9%). The insertion of ML and PICC catheters represented annual estimated economic savings of €867,688.44€. CONCLUSIONS: Our study provides a detailed analysis of VAT's activity, its relevance to clinical safety, and to efficient resource management within our hospital. It demonstrates how VAT establishment can be a safe and efficient intervention that enhances care quality.

"Core out" or "curettage" in rectal advancement flap for cryptoglandular anal fistula.

AIM: Transanal advancement flap is a recognized technique for complex fistula. Management of the tract is open to discussion. Excision of the tract by the "core out" technique is difficult and could increase the risk of sphincter damage. Curettage is easier but it could increase the risk of recurrence. The aim of the present study was to assess the effect of both techniques on sphincter function and to study the clinical results. METHOD: This is a retrospective analysis from a prospective database. One hundred nineteen consecutive patients with high cryptoglandular anal fistula were included. "Core out" technique was performed in 78 patients (group I) and "curettage" in 41 (group II). In both, a full-thickness rectal flap was advanced over the closed internal defect. Anorectal manometry was performed to assess sphincter function. Continence was assessed using the Wexner Scale. Recurrence was defined as the presence of an abscess or fistulization. RESULTS: Manometric results showed a significant decrease in the maximum resting pressure after surgery in both groups. The maximum squeeze pressure was significantly reduced only in group I (p < 0.001). No significant changes in Wexner score were observed. The overall recurrence rate was 5.88%, five of group I (6.4%) and two of group II (4.9%), without statistical significance (p = 0.74). CONCLUSIONS: The core-out technique causes a significant decrease in squeeze pressures, which reflects damage to the external anal sphincter. This could lead to incontinence in high-risk patients. Curettage is a simple technique that preserves the values of squeeze pressures without increasing recurrence rates.

Long bone development requires a threshold of Hox function.

The Hoxd(Del(11-13)) mutant is one of the animal models for human synpolydactyly, characterized by short and syndactylous digits. Here we have characterized in detail the cartilage and bone defects in these mutants. We report two distinct phenotypes: (i) a delay and change in pattern of chondrocyte maturation of metacarpals/metatarsals and (ii) formation of a poor and not centrally positioned primary ossification center in the proximal-intermediate phalanx. In the metacarpals of Hoxd(Del(11-13)) mutants, ossification occurs postnataly, in the absence of significant Ihh expression and without the establishment of growth plates, following patterns similar to those of short bones. The strong downregulation in Ihh expression is associated with a corresponding increase of the repressor form of Gli3. To evaluate the contribution of this alteration to the phenotype, we generated double Hoxd(Del(11-13));Gli3 homozygous mutants. Intriguingly, these double mutants showed a complete rescue of the phenotype in metatarsals but only partial phenotypic rescue in metacarpals. Our results support Hox genes being required in a dose-dependent manner for long bone cartilage maturation and suggest that and excess of Gli3R mediates a significant part of the Hoxd(Del(11-13)) chondrogenic phenotype.

Efficacy of a brief multifactorial adherence-based intervention on reducing the blood pressure of patients with poor adherence: protocol for a randomized clinical trial.

BACKGROUND: Lowering of blood pressure by antihypertensive drugs reduces the risks of cardiovascular events, stroke, and total mortality. However, poor adherence to antihypertensive medications reduces their effectiveness and increases the risk of adverse events. In terms of relative risk reduction, an improvement in medication adherence could be as effective as the development of a new drug. METHODS/DESIGN: The proposed randomized controlled trial will include patients with a low adherence to medication and uncontrolled blood pressure. The intervention group will receive a multifactorial intervention during the first, third, and ninth months, to improve adherence. This intervention will include motivational interviews, pill reminders, family support, blood pressure self-recording, and simplification of the dosing regimen. MEASUREMENT: The primary outcome is systolic blood pressure. The secondary outcomes are diastolic blood pressure, proportion of patients with adequately controlled blood pressure, and total cost. DISCUSSION: The trial will evaluate the impact of a multifactorial adherence intervention in routine clinical practice. Ethical approval was given by the Ethical Committee on Human Research of Balearic islands, Spain (approval number IB 969/08 PI).