[Informed consent: opinions of health care personnel from a teaching hospital]. / Consentimiento informado: opiniones del personal sanitario de un hospital universitario.

OBJECTIVE: To conduct a descriptive analysis of the opinions of health care personnel regarding different aspects related with the informed consent, and mainly the information given on informed consent forms. MATERIAL AND METHODS: All health care professionals (physicians, nurses and nursing auxiliaries) of a teaching hospital were invited to fill out an anonymous, 20-item questionnaire based on legal health guidelines. Degree of knowledge was assessed by age, professional and seniority status, speciality or position and bioethical background. RESULTS: The questionnaire was filled out by 277 participants, with a hospital participation of 67%. A total of 45.1% of the health care professionals believed they had insufficient information on what the informed consent consists of and when it should be completed by patients; 81.2% considered that informed consent is an instrument of professional protection against demands by the user; 62.8% thought that the information provided is not sufficiently clear to the patient; 76.2% that the reading and understanding are difficult for the average person and 37.9% considered that there is excessive information. Regarding the basic elements that should be included in the informed consent form, 96.7% advocate information, 93.5% comprehension, 84.1% willingness and 74% competence. A total of 98.9% of participants believed that side effects of a diagnostic or therapeutic intervention should be specified in the document, 57% the likelihood of success and 70.8% alternatives. Furthermore, 59.6% are not in favor of using numerical percentages to express procedure risks. CONCLUSIONS: Half of health-care professionals were unaware of what an informed consent consists of, its different sections, the law that regulates it and the philosophy underlying its development.

Consentimiento informado: opiniones del personal sanitario de un hospital universitario / Informed consent: opinions of health care personnel from a teaching hospital

Objetivo. Efectuar un análisis descriptivo de las opiniones del personal sanitario acerca de aspectos relacionados con el consentimiento informado, y muy especialmente de la información contenida en los formularios del mismo. Material y métodos. Estudio basado en la normativa legal sanitaria mediante la observación participante en forma de encuesta anónima de 20 preguntas a todos los profesionales médicos, diplomados y auxiliares en enfermería de un hospital universitario, evaluando la edad, la categoría y años de ejercicio profesional, la especialidad o puesto de trabajo y la formación previa en bioética. Resultados. Contestaron la encuesta 277 profesionales, con una participación hospitalaria del 67%. El 45,1% de los profesionales sanitarios consideró no tener suficiente información sobre el consentimiento informado y cuándo se debe cumplimentar por el paciente, y el 81,2% opinó que es un instrumento de protección ante demandas por parte del usuario. El 62,8% manifestó que la información proporcionada al paciente no es suficientemente aclaratoria, el 76,2% que es de difícil lectura y entendimiento por el usuario, y según el 37,9% adolece de excesiva información. En cuanto a los elementos básicos que debe reunir el documento del consentimiento informado, el 96,7% abogó por la información, el 93,5% por la comprensión, el 84,1% por la voluntariedad y el 74% por la competencia. Según el 98,9% de los participantes deberían constar en el documento los riesgos del procedimiento diagnóstico/terapéutico, según el 57% las posibilidades de éxito y según el 70,8% las alternativas existentes. El 59,6% no fue partidario de utilizar porcentajes numéricos para expresar los riesgos del procedimiento a realizar. Conclusiones. La mitad de los profesionales sanitarios desconoce lo que es un consentimiento informado, las partes que lo integran, la ley que lo regula y la filosofía con que fue creado (AU)

Objective. To conduct a descriptive analysis of the opinions of health care personnel regarding different aspects related with the informed consent, and mainly the information given on informed consent forms. Material and methods. All health care professionals (physicians, nurses and nursing auxiliaries) of a teaching hospital were invited to fill out an anonymous, 20-item questionnaire based on legal health guidelines. Degree of knowledge was assessed by age, professional and seniority status, speciality or position and bioethical background. Results. The questionnaire was filled out by 277 participants, with a hospital participation of 67%. A total of 45.1% of the health care professionals believed they had insufficient information on what the informed consent consists of and when it should be completed by patients; 81.2% considered that informed consent is an instrument of professional protection against demands by the user; 62.8% thought that the information provided is not sufficiently clear to the patient; 76.2% that the reading and understanding are difficult for the average person and 37.9% considered that there is excessive information. Regarding the basic elements that should be included in the informed consent form, 96.7% advocate information, 93.5% comprehension, 84.1% willingness and 74% competence. A total of 98.9% of participants believed that side effects of a diagnostic or therapeutic intervention should be specified in the document, 57% the likelihood of success and 70.8% alternatives. Furthermore, 59.6% are not in favor of using numerical percentages to express procedure risks. Conclusions. Half of health-care professionals were unaware of what an informed consent consists of, its different sections, the law that regulates it and the philosophy underlying its development (AU)

[Sex influence in lipodystrophy of HIV-infected patients and its association with cardiovascular risk factors]. / Impacto del sexo en el síndrome de lipodistrofia en pacientes con infección por el VIH y su asociación con factores de riesgo cardiovascular.

OBJECTIVE: To evaluate the influence of sex in human immunodeficiency virus (HIV)-infected patients with lipodystrophy and its association with cardiovascular risk factors. PATIENTS AND METHOD: A cross-sectional study was conducted in HIV-infected patients aged 20 or over managed at the outpatient Infectious Disease Unit in 2003. Clinical and epidemiological characteristics of HIV infection, lipodystrophy and cardiovascular risk factors were evaluated. RESULTS: Of the 760 patients included in the study, women comprised 28%. Men with lipodystrophy had a higher prevalence of hypertension, hypercholesterolemia, hypoalphalipoproteinemia and hypertriglyceridemia than those without lipodystrophy. Women with lipodystrophy had a higher prevalence of central obesity and hypertriglyceridemia compared with those without lipodystrophy (22.8 vs. 11.2%, p = 0.000; 20.6 vs. 9.3%, p = 0.001; 39.7 vs. 30%, p = 0.03 y 56.6 vs. 40.9%, p = 0.0001, respectively). The lipoatrophy pattern was predominant in men (24.9 vs. 12.6%, p = 0.0001) and lipoaccumulation forms in women (12.3 vs. 22.6%, p = 0.0001). Furthermore, women were younger, had a higher prevalence of smoking, family history of premature coronary heart disease and central obesity, and a lower prevalence of hypertension and hypoalphalipoproteinemia than men with lipodystrophy (42.1 +/- 8 years vs. 44.8 +/- 9.9 years, p = 0.03; 77.5 vs. 64%, p = 0.04; 22.5 vs. 9%, p = 0.003; 31 vs. 8.5%, p = 0.0001; 9.9 vs. 22.8%, p = 0.01; 25.4 vs. 39.7%, p = 0.03). CONCLUSIONS: This study demonstrated that the influence of sex in lipodystrophy in HIV-infected patients affects not only the lipodystrophy pattern, but also the cardiovascular risk profile.

Impacto del sexo en el síndrome de lipodistrofia en pacientes con infección por el VIH y su asociación con factores de riesgo cardiovascular / Sex influence in lipodystrophy of HIV-infected patients and its association with cardiovascular risk factors

Objetivo: Evaluar el impacto del sexo en la presencia del síndrome de lipodistrofia en una población de pacientes infectados por el VIH y su asociación con los factores de riesgo cardiovascular. Pacientes y método: Estudio transversal que incluyó a los pacientes de 20 años de edad o mayores, con infección por el VIH atendidos en la consulta externa del Servicio de Medicina Interna y Enfermedades Infecciosas del Hospital del Mar de Barcelona durante el año 2.003. Se evaluaron las características clínico-epidemiológicas de la infección por el VIH, la presencia de lipodistrofía y los factores de riesgo cardiovascular. Resultados: De los 710 pacientes incluidos en el estudio, las mujeres representaban el 28% de la serie. Los varones con lipodistrofia presentaron una mayor prevalencia de hipertensión arterial, hipercolesterolemia, hipoalfalipoproteinemia e hipertrigliceridemia comparado con los que no presentaban lipodistrofia (22,8 vs. 11,2%, p = 0,000; 20,6 vs. 9,3%, p = 0,001; 39,7 vs. 30%, p = 0,03 y 56,6 vs. 40,9%, p = 0,0001, respectivamente). En las mujeres, la presencia de lipodistrofia se acompañó de una mayor prevalencia de obesidad central e hipertrigliceridemia con respecto a la ausencia de lipodistrofia. En los varones predominó el patrón de lipoatrofia (24,9 vs. 12,6%, p = 0,0001), y en las mujeres el lipoacúmulo (12,3 vs. 22,6%, p = 0,0001). Además, las mujeres eran más jóvenes, tenían una mayor prevalencia de tabaquismo, antecedentes familiares de cardiopatía isquémica prematura y de obesidad central, y una menor prevalencia de hipertensión arterial y de hipoalfalipoproteinemia que los varones con lipodistrofia (42,1 ± 8 años vs. 44,8 ± 9,9 años, p = 0,03; 77,5 vs. 64%, p = 0,04; 22,5 vs. 9%, p = 0,003; 31 vs. 8,5%, p = 0,0001; 9,9 vs. 22,8%, p = 0,01; 25,4 vs. 39,7%, p = 0,03, respectivamente). Conclusiones: El presente estudio demuestra que el impacto del sexo en la lipodistrofia de los pacientes con infección por el VIH no sólo afecta al patrón de lipodistrofia, sino también al perfil de riesgo cardiovascular

Objective: To evaluate the influence of sex in human immunodeficiency virus (HIV)-infected patients with lipodystrophy and its association with cardiovascular risk factors. Patients and method: A cross-sectional study was conducted in HIVinfected patients aged 20 or over managed at the outpatient Infectious Disease Unit in 2003. Clinical and epidemiological characteristics of HIV infection, lipodystrophy and cardiovascular risk factors were evaluated. Results: Of the 760 patients included in the study, women comprised 28%. Men with lipodystrophy had a higher prevalence of hypertension, hypercholesterolemia, hypoalphalipoproteinemia and hypertriglyceridemia than those without lipodystrophy. Women with lipodystrophy had a higher prevalence of central obesity and hypertriglyceridemia compared with those without lipodystrophy (22.8 vs. 11.2%, p = 0.000; 20.6 vs. 9.3%, p = 0.001; 39.7 vs. 30%, p = 0.03 y 56.6 vs. 40.9%, p = 0.0001, respectively). The lipoatrophy pattern was predominant in men (24.9 vs. 12.6%, p = 0.0001) and lipoaccumulation forms in women (12.3 vs. 22.6%, p = 0.0001). Furthermore, women were younger, had a higher prevalence of smoking, family history of premature coronary heart disease and central obesity, and a lower prevalence of hypertension and hypoalphalipoproteinemia than men with lipodystrophy (42.1 ± 8 years vs. 44.8 ± 9.9 years, p = 0.03; 77.5 vs. 64%, p = 0.04; 22.5 vs. 9%, p = 0.003; 31 vs. 8.5%, p = 0.0001; 9.9 vs. 22.8%, p = 0.01; 25.4 vs. 39.7%, p = 0.03). Conclusions: This study demonstrated that the influence of sex in lipodystrophy in HIV-infected patients affects not only the lipodystrophy pattern, but also the cardiovascular risk profile

Efectividad de la ventilación no invasiva, modalidad BIPAP con máscara facial, en el paciente EPOC con insuficiencia respiratoria hipercápnica (acidosis respiratoria) en el Áreade Urgencias / Effectiveness of noninvasive positive pressure ventilation type BIPAP with face mask in patients with COPD and acute respiratory failure with hypercapnia (respiratory acidosis), in the Emergency Department

Objetivo: Evaluar la efectividad de la ventilación no invasiva (VNI) modalidad BIPAP, con máscara facial, en pacientes EPOC con insuficiencia respiratoria hipercápnica grave (acidosis respiratoria), en el Área de Urgencias (UCIAS). Métodos: Pacientes EPOC que ingresaron en UCIAS con insuficiencia respiratoria hipercápnica, en los que, a pesar del tratamiento convencional, persistían parámetros gasométricos de acidosis respiratoria. Se analizaron: edad, sexo, antecedentes, causas de descompensación, SAPS II, características de la radiografía, equilibrio ácido-base y frecuencia respiratoria seriada, escala de encefalopatía, tiempo de instauración y duración de la BIPAP, complicaciones de la mascarilla facial, fracasos del sistema BIPAP, mortalidad y estancia media hospitalaria. Resultados: Gasometría seriada (inicio BIPAP, 6-12 h, 24 h y final BIPAP): pH: 7,28ñ0,04, 7,32ñ0,05, 7,34ñ0,07, 7,37ñ0,04; PaO2: 61,48ñ18,4, 68,33ñ17,2, 71,94ñ20, 70,92ñ14,8; PaCO2: 76,69ñ13,6, 67,52ñ12,8, 64,40ñ12,5, 58,58ñ8,9, CO3H2: 34,9ñ4,5, 34,3ñ5,2, 34,02ñ5, 33,8ñ4,5.Conclusiones: La aplicación de la BIPAP en pacientes EPOC con insuficiencia respiratoria hipercápnica grave (acidosis respiratoria), normaliza el pH y disminuye la PaCO2. Al ser de manejo sencillo, permite su aplicación precoz en el Área de Urgencias, disminuyendo el número de ingresos en la UCI (mejor relación coste-beneficio) (AU)

[Hodgkin's disease and infection with human immunodeficiency virus]. / Enfermedad de Hodgkin e infección por el virus de la inmunodeficiencia humana.

Three patients with Hodgkin's disease, mixed cellularity subtype, plus infection by human immunodeficiency virus are presented. Two of them were intravenous drug abusers, and one had promiscuous heterosexual behaviour; they all presented B-type symptoms. One patient died because of infection, whereas the other two persisted in complete remission after treatment at 4 and 5 years of follow-up, respectively. None of the patients still alive has developed AIDS. The criteria for considering Hodgkin's disease as an AIDS-related lymphoproliferative disorder are discussed.

[Bacteremia of cutaneous origin]. / Bacteriemia de origen cutáneo.

558 episodes of bacteremia were detected in our medical center during a 2-year period. 17 of them (3%) were of cutaneous origin. 12 cases were community-acquired and 5 were hospital-acquired. The patients median age was of 65 years. 15 patients had a baseline disease, the most frequent being diabetes mellitus and neoplastic disease. The most common bacteria isolated were group A beta-hemolytic Streptococcus, Staphylococcus aureus, and Escherichia coli; 2 patients had multibacterial episodes. Decubitus ulcer and cellulitis were the most frequently associated skin disease. Global mortality was of 47% and was sepsis related in 29% of the cases. Death prognosis factors were old age, diabetes mellitus, gram-negative causal bacteria, nonappropriate antibiotic therapy, low index of clinical suspicion.