Fecal immunochemical test for hemoglobin versus fecal calprotectin to monitor endoscopic activity in inflammatory bowel disease.

AIM: endoscopy identifies inflammatory activity, however, it is an unpleasant test and is not always accessible. The aim of the study was to compare the usefulness of quantitative fecal immunochemical test (FIT) versus fecal calprotectin (FC) to determine endoscopic activity in patients with inflammatory bowel disease (IBD). METHODS: cross-sectional prospective observational study. The stool samples were collected within three days before starting the preparation for the colonoscopy. We used the Mayo index for ulcerative colitis (UC) and the simplified endoscopic index for Crohn's disease (CD). Mucosal healing (MH) was defined as the score 0 points in each of the endoscopic indices. RESULTS: eighty-four patients were included, 40 (47.6 %) with UC. In patients with IBD, FIT and FC showed a significant correlation with the presence of inflammatory activity/MH on endoscopy, with no statistically significant differences between the two receiver-operating characteristic (ROC) curves. Both tests improved their diagnostic performance when assessing patients with UC; the Spearman correlations between FIT and FC and endoscopic inflammatory activity were r = 0.6 (p = 0.0001) and r = 0.7 (p = 0.0001), respectively. In Crohn's disease, the diagnostic utility of both tests was lower. CONCLUSIONS: FIT is an alternative to monitor endoscopic activity among ulcerative colitis patients. In Crohn's disease, more studies are needed to determine the role of fecal biomarkers.

[Validation and transcultural adaptation to spanish of the "Parental Supervision Attributes Profile Questionnaire"]. / Validación y adaptación transcultural al español del Parental Supervision Attributes Profile questionnaire: método de medición de la supervisión parental.

OBJECTIVE: Child accidents are the most important preventable cause of morbidity and mortality in pediatric age. The degree of parental supervision is a factor that can influence, among others, in these accidents. The aim of this study was to validate and cross-culturally adapt to Spanish the questionnaire Parental Supervision Attributes Profile Questionnaire (PSAPQ) as a method of measuring the degree of parental supervision. METHODS: Forward and back-translation methodology was applied using 4 bilingual spanish-english people to obtain version 1.0 of the questionnaire. Subsequently, the questionnaire was reviewed by a committee of experts, obtaining version 1.1, which was provided to 149 parents of children between 2-5 years old, randomly obtained, who attended consultation for the well child visits in several health centers in the province of Valencia. For the statistical study, the internal consistency was analyzed using Cronbach's α test and the test-retest reliability using Pearson correlations. RESULTS: A very good internal consistency was obtained, with Cronbach's α values greater than 0.7 in three of the four subscales that make up the test, with the remaining being 0.68. The reliability obtained was excellent, with values with Pearson correlations close to or higher than 0.7 for all subscales. CONCLUSIONS: The PSAPQ translated and validated into spanish shows very good psychometric results with respect to the original, so it can be said that an adequate instrument has been obtained to objectively measure one of the possible risk factors of child accidents.

OBJETIVO: Los accidentes infantiles son la causa prevenible más importante de morbi-mortalidad en edad pediátrica. El grado de supervisión parental es un factor que puede influir, entre otros, en su aparición. El objetivo de este estudio fue validar y adaptar transculturalmente al español el cuestionario Parental Supervision Attributes Profile Questionnaire (PSAPQ) como método de medida del grado de supervisión de los padres a sus hijos. METODOS: Se empleó una metodología de traducción/retrotraducción mediante 4 personas bilingües (españolinglés), obteniéndose la versión 1.0 del cuestionario. Posteriormente, fue revisada por un comité de expertos, obteniéndose la versión 1.1, que se proporcionó a 149 padres de niños de entre 2-5 años, reclutados de forma aleatoria, que acudían a las revisiones del programa de salud infantil de diversos centros de salud de la provincia de Valencia. En el estudio estadístico se analizó la consistencia interna mediante el test alfa de Cronbach y la fiabilidad test-retest mediante correlaciones de Pearson. RESULTADOS: Se obtuvo buena consistencia interna, con valores de alfa de Cronbach mayores de 0,7 en tres de las cuatro subescalas que forman el test. En la restante se consiguió un valor de 0,68. En cuanto a la fiabilidad, se obtuvieron correlaciones de Pearson cercanas o superiores a 0,7 para todas las subescalas. CONCLUSIONES: El PSAPQ traducido y validado al idioma español muestra muy buenos resultados psicométricos respecto al original, por lo que se puede afirmar que se ha obtenido un instrumento adecuado para medir objetivamente uno de los posibles factores de riesgo de accidentes infantiles.

Propuesta de un repertorio bibliográfico sobre enfermedad crónica avanzada y cuidados paliativos / Proposal of a bibliographic repertoire on advanced chronic disease and palliative care

OBJETIVO: Identificar las publicaciones seriadas sobre enfermedad crónica avanzada y cuidados paliativos, y ordenarlas según su visibilidad e impacto. MÉTODO: Se buscaron las publicaciones seriadas que aparecen en MIAR (Matriz de Información para el Análisis de Revistas) o en Ullrichs (base de publicaciones seriadas) que trataran sobre diferentes aspectos del cuidado en enfermos terminales y crónicos avanzados. Se seleccionaron aquellas revistas que al menos estaban incluidas en bases de datos especializadas (MEDLINE, EMBASE, CINAHL y PsiCInfo) y cuyo impacto estuviera evaluado en una base de datos de citas (Journal Citation Reports o en Scopus). La selección de las revistas se hizo por al menos dos observadores, y en caso de duda se consultó la descripción de la revista ("aim and scope"). El listado final fue ordenado según el índice de visibilidad ICDS (Índice Compuesto de Difusión Secundaria). RESULTADOS: Se recuperaron y seleccionaron 39 publicaciones seriadas, 27 indexadas en Medline, 27 en Embase, 23 en Cinahl y 14 en PsycInfo. La visibilidad fue alta (ICDS = 9) en 23 revistas (59 %). Salvo dos, todas se publican en inglés. CONCLUSIONES: La enfermedad crónica avanzada y los cuidados paliativos dispone de un repertorio bibliográfico amplio y de alta visibilidad. Este repertorio puede utilizarse en la selección de revistas a revisar en sesiones clínicas, grupos de lectura crítica, etc., y como criterio de priorización a la hora de publicar un trabajo de investigación sobre el tema

OBJECTIVE: Identify serial publications on advanced chronic disease and palliative care and classify them according to visibility and impact. METHODS: We looked for serial publications included in MIAR (Matrix of Information for the Analysis of Journals) or Ullrichs (serial publications catalog) that will deal with different aspects of palliative care and advanced chronic patients. We selected those journals that were at least included in specialized databases (Medline, Embase, Cinahl and PsiCInfo) and whose impact was evaluated in a citation database (Journal Citation Reports or Scopus). The selection of the magazines was made by at least two observers and in case of doubt the description of the magazine (aim and scope) was consulted. The final listing was ranked according to the ICDS (Composite Secondary Diffusion Index) visibility index. RESULTS: We retrieved and selected 39 serials, 27 indexed in MEDLINE, 27 in EMBASE, 23 in CINAHL and 14 in PsycInfo. The visibility was high (ICDS = 9) in 23 journals (59 %). Except two, all are published in English. CONCLUSIONS: Advanced chronic disease and palliative care have a broad and high-visibility bibliographic repertoire. This repertoire can be used in the selection of journals to be reviewed in clinical sessions, critical reading groups, etc. and as a criterion of prioritization when publishing a research paper on the subject

Lesiones gastrointestinales en pacientes con enfermedad renal crónica y anemia / Gastrointestinal lesions in chronic kidney disease patients with anaemia

Introducción: A pesar de la frecuencia con que la anemia está presente en los pacientes con enfermedad renal crónica (ERC), su relación con lesiones gastrointestinales no ha sido estudiada. Método: Estudio observacional analítico transversal de un año de reclutamiento para determinar la prevalencia de lesiones gastrointestinales endoscópicas y los factores de riesgo asociados en pacientes asintomáticos con ERC estadios 1-5 y anemia que presentaban un test inmunoquímico cualitativo de sangre oculta en heces positivo. Resultados: Se analizaron 9.658 pacientes con ERC, de los que 286 (2,9%) presentaban anemia; 198 tuvieron un test de sangre oculta en heces positivo (47% varones, 71,1 ± 11,8 años). El estudio endoscópico reveló 255 lesiones, con al menos una lesión en el 68,2%, siendo las más prevalentes: pólipos colorrectales adenomatosos (39,6%), lesiones agudas de la mucosa gástrica (22,6%), lesiones neoplásicas (15,1%), angiodisplasias (14,4%), esofagitis (8,4%), enfermedad inflamatoria intestinal (4,8%) y colitis isquémica (3,1%). La uremia y el ácido acetilsalicílico fueron identificados como factores de riesgo de lesiones agudas de la mucosa gástrica. Las angiodisplasias se relacionaron con el enolismo, el mayor estadio de ERC, la anemia y la ausencia de respuesta a agentes estimulantes de la eritropoyesis. La edad y la anemia refractaria constituyeron factores de riesgo de pólipos adenomatosos y cáncer colorrectal. Conclusión: Los pacientes renales con anemia podrían beneficiarse de un estudio endoscópico debido a la alta prevalencia de lesiones gastrointestinales que presentan, particularmente pólipos adenomatosos y cáncer colorrectal, más frecuentes en los mayores de 50 años con ERC estadios 3-5

Introduction: Despite the frequency with which anaemia is present in patients with chronic kidney disease (CKD), its relationship with gastrointestinal lesions has not been studied. Method: A cross-sectional, analytical, observational study involving one year of recruitment was carried out to determine the prevalence of endoscopic gastrointestinal lesions and associated risk factors in asymptomatic patients with chronic kidney disease stages 1-5 and anaemia who had a positive qualitative immunochemical faecal occult blood test. Results: A total of 9,658 patients with CKD were analysed, of which 286 (2.9%) had anaemia; 198 had a positive faecal occult blood test (47% male, 71.1 ± 11.8 years). The endoscopic study revealed 255 lesions, with at least one lesion in 68.2% of patients, with the most prevalent being: adenomatous colorectal polyps (39.6%), acute lesions of the gastric mucosa (22.6%), neoplastic lesions 15.1%), angiodysplasia (14.4%), oesophagitis (8.4%), inflammatory bowel disease (4.8%) and ischaemic colitis (3.1%). Uraemia and acetylsalicylic acid were identified as risk factors for acute gastric mucosal lesions. Angiodysplasia was associated with alcoholism, a more advanced stage of chronic kidney disease, anaemia, and lack of response to erythropoiesis-stimulating agents. Age and refractory anaemia were risk factors for adenomatous polyps and colorectal cancer. Conclusion: Renal patients with anaemia could benefit from an endoscopic study due to their high prevalence of gastrointestinal lesions, particularly adenomatous polyps and colorectal cancer, which are more common in those over 50 years of age with CKD stages 3-5

Gastrointestinal lesions in chronic kidney disease patients with anaemia. / Lesiones gastrointestinales en pacientes con enfermedad renal crónica y anemia.

INTRODUCTION: Despite the frequency with which anaemia is present in patients with chronic kidney disease (CKD), its relationship with gastrointestinal lesions has not been studied. METHOD: A cross-sectional, analytical, observational study involving one year of recruitment was carried out to determine the prevalence of endoscopic gastrointestinal lesions and associated risk factors in asymptomatic patients with chronic kidney disease stages 1-5 and anaemia who had a positive qualitative immunochemical faecal occult blood test. RESULTS: A total of 9,658 patients with CKD were analysed, of which 286 (2.9%) had anaemia; 198 had a positive faecal occult blood test (47% male, 71.1±11.8 years). The endoscopic study revealed 255 lesions, with at least one lesion in 68.2% of patients, with the most prevalent being: adenomatous colorectal polyps (39.6%), acute lesions of the gastric mucosa (22.6%), neoplastic lesions 15.1%), angiodysplasia (14.4%), oesophagitis (8.4%), inflammatory bowel disease (4.8%) and ischaemic colitis (3.1%). Uraemia and acetylsalicylic acid were identified as risk factors for acute gastric mucosal lesions. Angiodysplasia was associated with alcoholism, a more advanced stage of chronic kidney disease, anaemia, and lack of response to erythropoiesis-stimulating agents. Age and refractory anaemia were risk factors for adenomatous polyps and colorectal cancer. CONCLUSION: Renal patients with anaemia could benefit from an endoscopic study due to their high prevalence of gastrointestinal lesions, particularly adenomatous polyps and colorectal cancer, which are more common in those over 50 years of age with CKD stages 3-5.

Validación y adaptación transcultural al español del Parental Supervision Attributes Profile Questionnaire: método de medición de la supervisión parental / Validation and transcultural adaptation to spanish of the "Parental Supervision Attributes Profile Questionnaire"

OBJETIVO: Los accidentes infantiles son la causa prevenible más importante de morbi-mortalidad en edad pediátrica. El grado de supervisión parental es un factor que puede influir, entre otros, en su aparición. El objetivo de este estudio fue validar y adaptar transculturalmente al español el cuestionario Parental Supervision Attributes Profile Questionnaire (PSAPQ) como método de medida del grado de supervisión de los padres a sus hijos. MÉTODOS: Se empleó una metodología de traducción/retrotraducción mediante 4 personas bilingües (españolinglés), obteniéndose la versión 1.0 del cuestionario. Posteriormente, fue revisada por un comité de expertos, obteniéndose la versión 1.1, que se proporcionó a 149 padres de niños de entre 2-5 años, reclutados de forma aleatoria, que acudían a las revisiones del programa de salud infantil de diversos centros de salud de la provincia de Valencia. En el estudio estadístico se analizó la consistencia interna mediante el test alfa de Cronbach y la fiabilidad test-retest mediante correlaciones de Pearson. RESULTADOS: Se obtuvo buena consistencia interna, con valores de alfa de Cronbach mayores de 0,7 en tres de las cuatro subescalas que forman el test. En la restante se consiguió un valor de 0,68. En cuanto a la fiabilidad, se obtuvieron correlaciones de Pearson cercanas o superiores a 0,7 para todas las subescalas. CONCLUSIONES: El PSAPQ traducido y validado al idioma español muestra muy buenos resultados psicométricos respecto al original, por lo que se puede afirmar que se ha obtenido un instrumento adecuado para medir objetivamente uno de los posibles factores de riesgo de accidentes infantiles

OBJECTIVE: Child accidents are the most important preventable cause of morbidity and mortality in pediatric age. The degree of parental supervision is a factor that can influence, among others, in these accidents. The aim of this study was to validate and cross-culturally adapt to Spanish the questionnaire Parental Supervision Attributes Profile Questionnaire (PSAPQ) as a method of measuring the degree of parental supervision. METHODS: Forward and back-translation methodology was applied using 4 bilingual spanish-english people to obtain version 1.0 of the questionnaire. Subsequently, the questionnaire was reviewed by a committee of experts, obtaining version 1.1, which was provided to 149 parents of children between 2-5 years old, randomly obtained, who attended consultation for the well child visits in several health centers in the province of Valencia. For the statistical study, the internal consistency was analyzed using Cronbach's alfa test and the test-retest reliability using Pearson correlations. RESULTS: A very good internal consistency was obtained, with Cronbach's alfa values greater than 0.7 in three of the four subscales that make up the test, with the remaining being 0.68. The reliability obtained was excellent, with values with Pearson correlations close to or higher than 0.7 for all subscales. CONCLUSIONS: The PSAPQ translated and validated into spanish shows very good psychometric results with respect to the original, so it can be said that an adequate instrument has been obtained to objectively measure one of the possible risk factors of child accidents

Estudio de coste-efectividad del diagnóstico microbiológico de tuberculosis mediante geneXpert MTB/RIF(R) / Cost-effectiveness study of the microbiological diagnosis of tuberculosis using geneXpert MTB/RIF(R)

Introducción/Objetivo: Evaluar mediante un análisis de coste-efectividad la aplicación de una técnica de biología molecular al diagnóstico de tuberculosis frente a la alternativa diagnóstica clásica. Métodos: Se realizó un análisis de coste-efectividad para evaluar la aplicación teórica de un procedimiento de biología molecular que incluye 2 alternativas de una técnica para la detección precoz de Mycobacterium tuberculosis Complex y resistencia a rifampicina (alternativa1: una determinación a pacientes seleccionados; alternativa2: 2 determinaciones a todos los pacientes). Ambas alternativas se compararon con el procedimiento habitual de diagnóstico microbiológico de tuberculosis realizado a 1972 pacientes durante 2008-2012 (microscopia y cultivo). La medida de la efectividad se hizo en QALY y la incertidumbre se trató mediante análisis de sensibilidad univariable, multivariable y probabilístico. Resultados: Para el método habitual se obtuvo un valor de 8.588€/QALY. En la alternativa1 el gasto fue de 8.487€/QALY, mientras que en la alternativa2 el cociente coste-efectivo ascendió a 2.960€/QALY. La alternativa2 fue la de mayor eficiencia diagnóstica, alcanzando una reducción del 75% del número de días que un paciente con tuberculosis permanece sin tratamiento adecuado, así como una reducción del 70% del número de días que un paciente sin tuberculosis permanece ingresado. Conclusión: La aplicación de una técnica microbiológica molecular en el diagnóstico de tuberculosis es sumamente coste-efectiva frente al método habitual. Su introducción en el procedimiento diagnóstico de rutina supondría una mejora en la calidad asistencial de los pacientes al evitar ingresos y tratamientos innecesarios, reflejándose en un ahorro económico al hospital (AU)

Introduction/Objective: To perform a cost-effectiveness analysis of a molecular biology technique for the diagnosis of tuberculosis compared to the classical diagnostic alternative. Methods: A cost-effectiveness analysis was performed to evaluate the theoretical implementation of a molecular biology method including two alternative techniques for early detection of Mycobacterium tuberculosis Complex, and resistance to rifampicin (alternative1: one determination in selected patients; alternative2: two determinations in all the patients). Both alternatives were compared with the usual procedure for microbiological diagnosis of tuberculosis (staining and microbiological culture), and was accomplished on 1,972 patients in the period in 2008-2012. The effectiveness was measured in QALYs, and the uncertainty was assessed by univariate, multivariate and probabilistic analysis of sensitivity. Results: A value of €8,588/QALYs was obtained by the usual method. Total expenditure with the alternative1 was €8,487/QALYs, whereas with alternative2, the cost-effectiveness ratio amounted to €2,960/QALYs. Greater diagnostic efficiency was observed by applying the alternative2, reaching a 75% reduction in the number of days that a patient with tuberculosis remains without an adequate treatment, and a 70% reduction in the number of days that a patient without tuberculosis remains in hospital. Conclusion: The implementation of a molecular microbiological technique in the diagnosis of tuberculosis is extremely cost-effective compared to the usual method. Its introduction into the routine diagnostic procedure could lead to an improvement in quality care for patients, given that it would avoid both unnecessary hospitalisations and treatments, and reflected in economic savings to the hospital (AU)

Cost-effectiveness study of the microbiological diagnosis of tuberculosis using geneXpert MTB/RIF®. / Estudio de coste-efectividad del diagnóstico microbiológico de tuberculosis mediante geneXpert MTB/RIF®.

INTRODUCTION/OBJECTIVE: To perform a cost-effectiveness analysis of a molecular biology technique for the diagnosis of tuberculosis compared to the classical diagnostic alternative. METHODS: A cost-effectiveness analysis was performed to evaluate the theoretical implementation of a molecular biology method including two alternative techniques for early detection of Mycobacterium tuberculosis Complex, and resistance to rifampicin (alternative1: one determination in selected patients; alternative2: two determinations in all the patients). Both alternatives were compared with the usual procedure for microbiological diagnosis of tuberculosis (staining and microbiological culture), and was accomplished on 1,972 patients in the period in 2008-2012. The effectiveness was measured in QALYs, and the uncertainty was assessed by univariate, multivariate and probabilistic analysis of sensitivity. RESULTS: A value of €8,588/QALYs was obtained by the usual method. Total expenditure with the alternative1 was €8,487/QALYs, whereas with alternative2, the cost-effectiveness ratio amounted to €2,960/QALYs. Greater diagnostic efficiency was observed by applying the alternative2, reaching a 75% reduction in the number of days that a patient with tuberculosis remains without an adequate treatment, and a 70% reduction in the number of days that a patient without tuberculosis remains in hospital. CONCLUSION: The implementation of a molecular microbiological technique in the diagnosis of tuberculosis is extremely cost-effective compared to the usual method. Its introduction into the routine diagnostic procedure could lead to an improvement in quality care for patients, given that it would avoid both unnecessary hospitalisations and treatments, and reflected in economic savings to the hospital.

How is inflammatory bowel disease managed in Spanish gastroenterology departments? The results of the GESTIONA-EII survey.

INTRODUCTION: Not all national health centers include specialized units or clinicians devoted to inflammatory bowel disease. The goal of the survey was to gain an insight into the management of this disease within Spanish gastroenterology departments via a survey among their members. MATERIAL AND METHODS: An online survey was conducted in February and March 2015, among SEPD members (2017 clinician members), who were split into three categories: heads of department, general gastroenterologists, and experts in this disease. The results of the last two surveys are reported, including demography-related questions and specific questions on the strategies and resources available for the care of these patients. RESULTS: A total of 166 responses were received (response rate 8.19%), excluding those from heads of department (previously published). Sixty gastroenterologists considered themselves experts in inflammatory bowel disease, and 106 non-experts in it, the latter being either general gastroenterologists or specialists in other areas, mainly endoscopy. Twenty-eight percent of non-expert gastroenterologists said their hospitals had specific units, with a monographic clinic in 46%. However, 26% reported that they were treating affected patients themselves. Experts in inflammatory bowel disease reported that their institute had resources to support their work, but there was a lack of surgeons with expertise in this condition, particularly in county hospitals. CONCLUSIONS: At least, within SEPD members, 2 out of 3 experts in inflammatory bowel disease seem to have the resources available for their work (nurses, day unit, telephone line, database, referrals, joint sessions). Although there is room for improvement (email to contact patients, devoted surgeon, absence of referral protocols), and 2 out of 3 are concerned about pharmacy costs. Since a substantial number of patients remain treated by general practitioners, rapid referral programs might be helpful in this setting.

Management of the clinical issue of constipation with abdominal complaints in adults. A national survey of Primary Care physicians and gastroenterologists.

Irritable bowel syndrome and functional constipation represent a relevant and common health issue. However, real-world clinical practice includes patients with constipation who may or may not have other abdominal complaints (pain, bloating, abdominal discomfort) with variable frequency. The goal of the present study was to obtain information on the workload entailed by patients with constipation and associated abdominal complaints, predominant clinical behaviors, education needs, and potential daily practice aids both in Primary Care and gastroenterology settings. The clinical behavior of doctors is generally similar at both levels, despite differences in healthcare approach: use of empiric therapies and clinically guided diagnostic tests, with some differences in colonoscopy use (not always directly accessible from Primary Care). Regarding perceptions, general support and osmotic laxatives are most valued by PC doctors, whereas osmotic laxatives, combined laxatives, and linaclotide are most valued by GE specialists. Furthermore, over half of respondents considered differentiating both diagnoses as challenging. Finally, considerable education needs are self-acknowledged at both levels, as is a demand for guidelines and protocols to help in managing this issue in clinical practice. A strength of this study is its providing a joint photograph of the medical approach and the perceptions of constipation with abdominal discomfort from a medical standpoint. Weaknesses include self-declaration (no formal validation) and a response rate potentially biased by professional motivation.

Riesgo cardiovascular asociado al consumo de antiinflamatorios no esteroideos. Estudio de cohortes retrospectivo en un área de salud, 2008-2012 / Cardiovascular risk associated with the use of non steroidal anti-inflammatory drugs. Cohort study

Fundamentos: Desde el ensayo clínico VIGOR cuyos resultados asociaron el uso del medicamento rofecoxib a la ocurrencia de eventos cardiovasculares se ha observado un aumento en patologías cardiovasculares asociadas al uso de antiinflamatorios no esteroideos. El objetivo de esta investigación fue evaluar el impacto cardiovascular asociado al consumo de antiinflamatorios en un Área de Salud de Castilla La-Mancha (España). Métodos: Estudio retrospectivo de cohortes de base poblacional en un área de salud del período 2008-2012. Se incluyó a todos los pacientes mayores de 18 años (116.686). El análisis estadístico se realizó estimando las incidencias de síndrome coronario agudo en relación al tiempo de exposición. Se calculó el riesgo relativo (RR) asociado al consumo de antiinflamatorios no esteroideos se modelizó mediante regresión de Poisson, ajustando por edad y sexo. También se calculó la Dosis Habitante Día (DHD) mediante la Dosis Diaria Definida. Resultados: La asociación entre el síndrome coronario agudo y el consumo de antiinflamatorios fue positiva (RR 3,64; IC95% 2,94-4,52; p<0,001). El riesgo cardiovascular fue mayor en las alcanonas (RR 18; IC95% 2,53-127; p=0,004), seguido de los propionoicos como el ibuprofeno (RR 2,58; IC95% 2,16-3,69; p<0,001), además es el único grupo que es tiempo-dependiente. En tercer lugar los arilacéticos (RR 1,88; IC95% 1,6-2,22; p<0,001) y por último los coxib (RR 1,55; IC95% 1,25- 1,92; p<0,001). En los demás antiinflamatorios no se observó aumento de riesgo cardiovascular. Conclusiones: El consumo de antiinflamatorios se asocia a un mayor riesgo de sufrir un síndrome coronario agudo sobretodo en los considerados como tradicionales, lo que sugiere que no se deberían tomar ni durante tiempo prolongado ni a altas dosis (AU)

Background: Since the clinical trial VIGOR, in which the use of rofecoxib was proved to be connected to a larger number of cardiovascular accidents, an increase of cardiovascular diseases connected to the use of non Steroidal Anti-Inflammatory Drugs has been observed. This study intends to evaluate cardiovascular impact related to the use of non steroidal anti-inflammatory drugs in a Health Care Area in Castilla La Mancha (Spain). Method: A retrospective observational study of clinical cohort during 5 years is done in which all patients older than 18 years (n = 116 686) was included. The statistical analysis was done estimating the incidence of acute coronary syndrome in relation to the exposure time. The risk associated with the consumption of non-steroidal anti-inflammatory drugs was made by Poisson regression adjusting by sex and age. Calculation of the Daily Inhabitants Doses by means of the Defined Daily Doses, through DIGITALIS program of pharmaceutical consumption. Results: The connection between acute coronary syndrome and the use of anti-inflammatory drugs was positive (RR 3,64; IC95% 2,94 a 4,52; p<0,001). The cardiovascular risk was higher en alkanones (RR 18; IC95% 2,53 a 127; p=0,004), followed by propionoicos as ibuprofen (RR 2,58; IC95% 2,16 a 3,69; p<0,001), it is also the only group that is time-dependent. Thirdly arylacetic (RR 1,88; IC95% 1,6 a 2,22; p<0,001) and finally the coxib (RR 1,55; IC95% 1,25 a 1,92; p<0,001), in others antiinflammatory no increased cardiovascular risk was observed. Conclusions: The use of non steroidal anti-inflammatory drugs has been connected to a higher risk of cardiovascular accidents, suggesting that not during prolonged or high-dose or should take (AU)

Adecuación del uso de absorbentes de incontinencia urinaria en pacientes adultos ingresados en un hospital / Appropriateness of the use of incontinence absorbent products in hospitalized adults

INTRODUCCIÓN: La utilización inapropiada de absorbentes de incontinencia en adultos puede afectar negativamente a la autoestima, calidad de vida, e independencia del paciente, así como aumentar la carga de trabajo y provocar eventos adversos. Existen pocos estudios que valoren la adecuación del uso del pañal utilizando escalas validadas para ello, ni la justificación de las enfermeras para su uso en personas mayores hospitalizadas. OBJETIVO: Determinar la frecuencia de uso de pañal en pacientes ingresados en un centro hospitalario así como identificar los criterios que determinaron su uso y el grado de adecuación. MÉTODO: Estudio observacional, transversal sobre pacientes adultos que utilizaban pañal estando ingresados en unidades de hospitalización. Para la recogida de datos se realizó un corte de un día en abril de 2013, recogiendo datos de los registros de valoración de enfermería y de los propios pacientes y familia. Se utilizaron como criterios de adecuación los ítems del Índice de Barthel referentes a movilidad y eliminación. RESULTADOS: De los 228 pacientes ingresados 83 (34,4%) llevaban pañal y de ellos 25 (30,1%) no tenían criterios para su uso. El 28,8% (21) no utilizaba pañal previamente al ingreso siendo en la mitad de ellos inadecuado su uso. Los factores asociados al uso inadecuado de pañal fueron mayor edad, sexo femenino, más comobilidad y días de ingreso. CONCLUSIÓN: Los resultados de este estudio ponen de manifiesto la excesiva frecuencia con la que se utilizan los absorbentes de incontinencia de forma inadecuada sin que su uso se base en criterios validados

BACKGROUNDS: Improper use of incontinence absorbent products in adults can negatively affect self-esteem, quality of life and independence of the patient, as well as increase the workload and cause adverse events. There are few studies evaluating the appropriateness of diapers using validated scales for it, or the justification of nurses for its use in elderly who are hospitalized. · To determine the frequency of diaper use in patients admitted to a hospital and to identify the criteria that determined their use and adequacy. · Observational, cross-sectional study of adult patients using diapers while admitted in Inpatient Units. For data collection cut day was held in April 2013, collecting data from nursing assessment records, patients themselves and their family. Barthel Index items were used as criteria of adequacy concerning mobility and disposal. Results: 228 patients admitted. 83 (34.4%) of them had diapers and 25 (30.1%) of them had no criteria for using them. 28.8% (21) had not previously used diapers, the use of diapers in half of them was inappropriate. Factors associated with inappropriate use of diapers were older age, being female, more comorbidity and days of hospitalization. · The results of this study show the often excessive use of incontinence absorbent products without proper appplication, not based on validated criteria

[Appropriateness of the use of incontinence absorbent products in hospitalized adults]. / Adecuación del uso de absorbentes de incontinencia urinaria en pacientes adultos ingresados en un hospital.

BACKGROUNDS: Improper use of incontinence absorbent products in adults can negatively affect self-esteem, quality of life and independence of the patient, as well as increase the workload and cause adverse events. There are few studies evaluating the appropriateness of diapers using validated scales for it, or the justification of nurses for its use in elderly who are hospitalized. OBJECTIVE: To determine the frequency of diaper use in patients admitted to a hospital and to identify the criteria that determined their use and adequacy. METHOD: Observational, cross-sectional study of adult patients using diapers while admitted in Inpatient Units. For data collection cut day was held in April 2013, collecting data from nursing assessment records, patients themselves and their family. Barthel Index items were used as criteria of adequacy concerning mobility and disposal. RESULTS: 228 patients admitted. 83 (34.4%) of them had diapers and 25 (30.1%) of them had no criteria for using them. 28.8% (21) had not previously used diapers, the use of diapers in half of them was inappropriate. Factors associated with inappropriate use of diapers were older age, being female, more comorbidity and days of hospitalization. CONCLUSION: The results of this study show the often excessive use of incontinence absorbent products without proper application, not based on validated criteria.

Asociación entre el síndrome coronario agudo y el consumo de antiinflamatorios no esteroideos / Association between acute coronary syndrome and use of non steroidal anti-inflammatory drug

Objetivos: Evaluar el impacto cardiovascular asociado al consumo de antiinflamatorios no esteroideos en un Área de Salud, estimando la asociación entre la prescripción previa de un antiinflamatorio no esteroideo al episodio de síndrome coronario agudo. Material y Métodos: Se realiza un estudio retrospectivo observacional de casos cruzados de 5 años de duración, del 1 de Enero de 2008 hasta el 31 de diciembre de 2012. Los pacientes en primer lugar fueron casos y controles (n=1.317) que tuvieron eventos cardiovasculares y fueron al servicio de Urgencias del Hospital por dicho motivo.Área de Salud de Alcázar de San Juan. Medida principal: Asociación del riesgo de sufrir un síndrome coronario agudo mediante el Odds Ratio con el consumo de antiinflamatorios no esteroideos Resultados: La asociación entre el síndrome coronario agudo y el consumo de Antiinflamatorios fue positiva y significativa, (OR 1,42; IC95% 1,06-1,9). Esta asociación fue de mayor magnitud en pacientes con menor comorbilidad, Charlson ≤ 1 (OR 1,66; IC95% 1,15 - 2,40) frente a los de mayor comorbilidad, Charlson > 1 (OR 1,07; IC95% 0,65 - 1,76). Esta modificación de efecto se debió en parte al consumo concomitante de fármacos que previenen contra patologías cardiovasculares como los antiagregantes, anticoagulantes y estatinas. Conclusiones: El consumo de antiinflamatorios no esteroideos se ha asociado a un mayor riesgo de síndrome coronario agudo, por lo que es necesario realizar un seguimiento a los pacientes que consuman estos fármacos, no debiéndose tomar durante tiempos prolongados ni a dosis altas (AU)

Aims: Evaluate cardiovascular impact related to the use of non steroidal anti-inflammatory drugs in a Health Area, by estimating the connection between the previous medical prescription of non steroidal anti-inflammatory medicines and acute coronary syndrome. Material and Methods: A retrospective observational study of clinical casecrosover during 5 years is done, from 1st of January 2008 to 31st of December 2012. In first place patients were cases and controls (n=1.317) who suffered cardiovascular accidents and went to Emergency Room. Setting: Alcazar de San Juan Health Care Area. Main measurements: Association of the risk of acute coronary syndrome by Odds Ratio with consumption of non anti-inflammatory drug. Results: The connection between acute coronary syndrome and the use of anti-inflammatory drugs was positive and significant (OR 1.42; IC95% 1.06-1.9), which means the probability of suffering a cardiovascular accident increases to 42% in patients taking non steroidal anti-inflammatory drugs. The connection between the prescription of anti-inflammatory drugs and acute coronary syndrome reached a bigger magnitude in patients with less comorbidity, Charlson ≤ 1 (OR 1.66; IC95% 1.15 - 2.40) as opposite to those with more comorbidity, Charlson > 1 (OR 1.07; IC95% 0.65 - 1.76). This change of effect was due, in part, to the concomitant use of medicines which prevent cardiovascular diseases, such as antiaggregant, anticoagulant and statins drugs. Conclusions: The use of non steroidal anti-inflammatory drugs has been connected to a higher risk of cardiovascular accidents; therefore it is necessary to realize follow-up patients who consume these drugs. These drugs must not be consumed for a long time or at high doses (AU)

Single-incision laparoscopic bariatric surgery: a systematic review.

BACKGROUND: Single-incision laparoscopic surgery has sparked a great deal of interest in the surgical community in recent years, including bariatric surgery. However, we still do not definitively know if this type of surgical approach provides benefits over conventional techniques without increasing morbidity and mortality. OBJECTIVE: To evaluate the safety and efficacy of single-incision laparoscopic bariatric surgery (SILBS) compared with conventional laparoscopic bariatric surgery (CLBS). MATERIALS AND METHODS: We searched the most important databases. Randomized clinical trials and observational studies comparing SILBS with CLBS were included. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. RESULTS: Fourteen studies complied with the inclusion criteria for our analysis, which included 2357 patients (1179 SILBS group versus 1178 CLBS group). The duration of surgery was longer in the SILBS group and no major intraoperative complications were observed in these series. A small improvement in postoperative pain was indicated in the SILBS group. The overall morbidity rate was 5% in the SILBS group and 4.8% in the CLBS. There was 1 perioperative death in 1 study, which occurred in an adjustable gastric banding (AGB) group, at .1% of all cases of AGB and .005% of all SILBS cases. When cosmesis was evaluated, patients in the SILBS group were more satisfied with the scar outcome. CONCLUSION: SILBS is a feasible technique to use in selected patients. However, there is insufficient evidence to recommend its widespread use compared with a conventional approach. More studies are needed to analyze the safety of this technique and its possible benefits.

[Cardiovascular risk associated with the use of non steroidal anti-inflammatory drugs: cohort study]. / Riesgo cardiovascular asociado al consumo de antiinflamatorios no esteroideos: estudio de cohortes retrospectivo en un área de salud, 2008-2012.

BACKGROUND: Since the clinical trial VIGOR, in which the use of rofecoxib was proved to be connected to a larger number of cardiovascular accidents, an increase of cardiovascular diseases connected to the use of non Steroidal Anti-Inflammatory Drugs has been observed. This study intends to evaluate cardiovascular impact related to the use of non steroidal anti-inflammatory drugs in a Health Care Area in Castilla La Mancha (Spain). METHOD: A retrospective observational study of clinical cohort during 5 years is done in which all patients older than 18 years (n = 116 686) was included. The statistical analysis was done estimating the incidence of acute coronary syndrome in relation to the exposure time. The risk associated with the consumption of non-steroidal anti-inflammatory drugs was made by Poisson regression adjusting by sex and age. Calculation of the Daily Inhabitants Doses by means of the Defined Daily Doses, through DIGITALIS program of pharmaceutical consumption. RESULTS: The connection between acute coronary syndrome and the use of anti-inflammatory drugs was positive (RR 3,64; IC95% 2,94 a 4,52; p<0,001). The cardiovascular risk was higher en alkanones (RR 18; IC95% 2,53 a 127; p=0,004), followed by propionoicos as ibuprofen (RR 2,58; IC95% 2,16 a 3,69; p<0,001), it is also the only group that is time-dependent. Thirdly arylacetic (RR 1,88; IC95% 1,6 a 2,22; p<0,001) and finally the coxib (RR 1,55; IC95% 1,25 a 1,92; p<0,001), in others antiinflammatory no increased cardiovascular risk was observed. CONCLUSIONS: The use of non steroidal anti-inflammatory drugs has been connected to a higher risk of cardiovascular accidents, suggesting that not during prolonged or high-dose or should take.

Exocrine pancreatic insufficiency and chronic pancreatitis in chronic alcoholic liver disease: coincidence or shared toxicity?

OBJECTIVES: The aims of this study were to determine the prevalence of exocrine pancreatic insufficiency (EPI) and chronic pancreatitis (CP) in patients with chronic alcoholic liver disease and to analyze the possible associated factors. METHODS: This is an analytical observational study of cases and controls for a sample of patients with chronic alcoholic and nonalcoholic liver disease. Exocrine pancreatic insufficiency was diagnosed using the C mixed-triglyceride breath test. Patients with abdominal pain underwent endoscopic ultrasonography for CP evaluation using the Wiersema criteria. RESULTS: A total of 154 patients were included, 129 with alcoholic liver disease (83 with cirrhosis) and 25 with nonalcoholic liver disease. Exocrine pancreatic insufficiency was found in 55.2% versus 16.7% (P < 0.001), 70% of patients without cirrhosis compared with 46.2% of patients with cirrhosis had pancreatic insufficiency (P = 0.017), and 82.7% of patients with alcoholic liver disease and abdominal pain had CP (P < 0.001). Exocrine pancreatic insufficiency was associated with the male sex, alcohol intake, abdominal pain, degree of liver failure, and the absence of portal hypertension. Chronic pancreatitis was correlated with age younger than 55 years and abdominal pain. CONCLUSIONS: Patients with alcoholic liver disease had a high prevalence of EPI and CP; this prevalence was even higher in patients who have not yet developed cirrhosis with liver failure or portal hypertension.

25 años de cirugía laparoscópica en España / 25 years of laparoscopic surgery in Spain

INTRODUCCIÓN: La introducción de la cirugía laparoscópica (CL) puede considerarse el avance más importante que ha experimentado nuestra especialidad en los últimos 25 años. A pesar de sus ventajas, la implantación y consolidación de la CL no ha sido homogénea, especialmente si tenemos en cuenta las técnicas laparoscópicas avanzadas. El objetivo de este trabajo es analizar el nivel de desarrollo e implantación de la CL en España en el momento actual y analizar su evolución en los últimos años. MATERIAL Y MÉTODOS: Durante el segundo semestre de 2012 se desarrolló una encuesta que evaluaba distintos aspectos relacionados con la implantación y el desarrollo de la CL en nuestro país. La encuesta se realizó mediante un cuestionario electrónico. RESULTADOS: La tasa global de respuesta a la encuesta fue del 16% y 103 jefes de Servicio contestaron el cuestionario. El 92% correspondió a cirujanos de centros sanitarios públicos. El 99% de los encuestados realizaba CL básica y el 85,2%, avanzada. La mayor parte de los encuestados (79%) considera que el instrumental y los equipos para CL de los que dispone son correctos y el 71% considera que, en su medio, la CL está en el lugar adecuado. CONCLUSIONES: La CL básica ha logrado desarrollarse en nuestro país hasta considerarse un estándar practicado por la mayoría de los cirujanos y ser parte de la formación básica del residente de cirugía. Con respecto a la CL avanzada, aunque los porcentajes de utilización son altos, todavía existen déficits y, en consecuencia, oportunidades de mejora

INTRODUCTION: The introduction of laparoscopic surgery (LS) can be considered the most important advancement in our specialty in the past 25 years. Despite its advantages, implementation and consolidation has not been homogenous, especially for advanced techniques. The aim of this study was to analyse the level of development and use of laparoscopic surgery in Spain at the present time and its evolution in recent years. MATERIAL AND METHODS: During the second half of 2012 a survey was developed to evaluate different aspects of the implementation and development of LS in our country. The survey was performed using an electronic questionnaire. RESULTS: The global response rate was 16% and 103 heads of Department answered the survey. A total of 92% worked in the public system. A total of 99% perform basic laparoscopic surgery and 85,2% advanced LS. Most of the responders (79%) consider that the instruments they have available for LS are adequate and 71% consider that LS is in the right stage of development in their environment. CONCLUSIONS: Basic laparoscopic surgery has developed in our country to be considered the standard performed by most surgeons, and forms part of the basic surgical training of residents. With regards to advanced LS, although it is frequently used, there are still remaining areas of deficit, and therefore, opportunities for improvement