Sistemas de monitorización continua de glucosa en tiempo real

Monitorització; Glucosa; Medicina basada en l'evidència; Monitoring; Glucose; Evidence-based medicine; Monitorización; Medicina basada en la evidenciaEls sistemes de monitoratge continu de la glucosa en temps real (SMCGTR) utilitzen dispositius mínimament invasius per mesurar els nivells de glucosa en el líquid intersticial que envolta les cèl·lules de la pell i proporcionar informació contínua sobre les fluctuacions de glucosa en sang. Es plantegen com una alternativa a la mesura de la glucosa mitjançant autopunció en pacients amb ràpides fluctuacions dels nivells de glucosa, o quan aquestes es produeixen durant la nit. L'objectiu d'aquest informe és analitzar l'evidència científica sobre l'eficàcia i la seguretat dels SMCGTR per al control de la glucosa en comparació de la tècnica estàndard d'autopunció digital en adults i població pediàtrica amb diabetis mellitus tipus 1 (DM1)

Validación del modelo predictivo de fractura osteoporótica FRAX

Osteoporosi; Avaluació; Fractura òssia; Osteoporosis; Evaluation; Bone fractures; Evaluación; Fractura óseaEl FRAX és una eina d'avaluació del risc de fractura osteoporòtica i de maluc per a homes i dones entre 40 i 90 anys. Fins ara no s'ha pogut realitzar la validació de la versió espanyola del FRAX en una cohort independent, recomanada fins i tot pels mateixos autors del model. Objectius: Analitzar la capacitat predictiva de la versió espanyola del model FRAX de predicció de fractura osteoporòtica, i de maluc, en una cohort de dones amb una densitometria òssia (DO) realitzada fa 10 anys o més. Metodologia: Cohort retrospectiva amb seguiment fins a fractura per fragilitat, d'una població de dones entre 40 i 90 anys amb una primera visita per fer una DO anterior a 1999

Validación del modelo predictivo de fractura osteoporótica FRAX

Herramienta de evaluación del riesgo de fractura; Modelo FRAX; Fracturas osteoporóticasFracture Risk Assessment Tool; FRAX model; Osteoporotic FracturesModel d'avaluació del risc de fractura; Model FRAX; Fractures osteoporòtiquesLa osteoporosis es un trastorno del sistema esquelético caracterizado por la pérdida de masa ósea y por el deterioro de la microarquitectura del tejido óseo, que predispone al individuo a una mayor fragilidad ósea y una mayor susceptibilidad a las fracturas. La fractura por fragilidad es la principal consecuencia de la osteoporosis. El FRAX es una herramienta de evaluación del riesgo de fractura osteoporótica y de cadera para hombres y mujeres de entre 40 y 90 años. Hasta la fecha no se ha podido realizar la validación de la versión española del FRAX en una cohorte independiente, recomendada incluso por los propios autores del modelo. El objetivo de este estudio ha sido analizar la capacidad predictiva de la versión española del modelo FRAX de predicción de fractura osteoporótica, y de cadera, en una cohorte de mujeres con una densitometría ósea (DO) realizada hace 10 años o más.L'osteoporosi és un trastorn del sistema esquelètic caracteritzat per la pèrdua de massa òssia i pel deteriorament de la microarquitectura del teixit ossi, que predisposa l'individu a una major fragilitat òssia i una major susceptibilitat a les fractures. La fractura per fragilitat és la principal conseqüència de l'osteoporosi. El FRAX és una eina d'avaluació del risc de fractura osteoporòtica i de maluc per a homes i dones d'entre 40 i 90 anys. Fins a la data no s'ha pogut realitzar la validació de la versió espanyola del FRAX en una cohort independent, recomanada fins i tot pels mateixos autors del model. L'objectiu d'aquest estudi ha estat analitzar la capacitat predictiva de la versió espanyola del model FRAX de predicció de fractura osteoporòtica, i de maluc, en una cohort de dones amb una densitometria òssia (DO) realitzada fa 10 anys o més

Attitudes and perceptions about clinical guidelines: a qualitative study with Spanish physicians

Estudio cuyo objetivo es la evaluación de las actitudes y percepciones los médicos españoles con relación las Guías de práctica clínica. Spanish physicians towards CGs

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Morbidity and mortality after anaesthesia in early life: results of the European prospective multicentre observational study, neonate and children audit of anaesthesia practice in Europe (NECTARINE)

Background: Neonates and infants requiring anaesthesia are at risk of physiological instability and complications, but triggers for peri-anaesthetic interventions and associations with subsequent outcome are unknown. Methods: This prospective, observational study recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. The primary aim was to identify thresholds of pre-determined physiological variables that triggered a medical intervention. The secondary aims were to evaluate morbidities, mortality at 30 and 90 days, or both, and associations with critical events. Results: Infants (n=5609) born at mean (standard deviation [SD]) 36.2 (4.4) weeks postmenstrual age (35.7% preterm) underwent 6542 procedures within 63 (48) days of birth. Critical event(s) requiring intervention occurred in 35.2% of cases, mainly hypotension (>30% decrease in blood pressure) or reduced oxygenation (SpO2 <85%). Postmenstrual age influenced the incidence and thresholds for intervention. Risk of critical events was increased by prior neonatal medical conditions, congenital anomalies, or both (relative risk [RR]=1.16; 95% confidence interval [CI], 1.04–1.28) and in those requiring preoperative intensive support (RR=1.27; 95% CI, 1.15–1.41). Additional complications occurred in 16.3% of patients by 30 days, and overall 90-day mortality was 3.2% (95% CI, 2.7–3.7%). Co-occurrence of intraoperative hypotension, hypoxaemia, and anaemia was associated with increased risk of morbidity (RR=3.56; 95% CI, 1.64–7.71) and mortality (RR=19.80; 95% CI, 5.87–66.7). Conclusions: Variability in physiological thresholds that triggered an intervention, and the impact of poor tissue oxygenation on patient's outcome, highlight the need for more standardised perioperative management guidelines for neonates and infants. Clinical trial registration: NCT02350348

Morbidity and mortality after anaesthesia in early life: results of the European prospective multicentre observational study, neonate and children audit of anaesthesia practice in Europe (NECTARINE)

BACKGROUND: Neonates and infants requiring anaesthesia are at risk of physiological instability and complications, but triggers for peri-anaesthetic interventions and associations with subsequent outcome are unknown. METHODS: This prospective, observational study recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. The primary aim was to identify thresholds of pre-determined physiological variables that triggered a medical intervention. The secondary aims were to evaluate morbidities, mortality at 30 and 90 days, or both, and associations with critical events. RESULTS: Infants (n=5609) born at mean (standard deviation [sd]) 36.2 (4.4) weeks postmenstrual age (35.7% preterm) underwent 6542 procedures within 63 (48) days of birth. Critical event(s) requiring intervention occurred in 35.2% of cases, mainly hypotension (>30% decrease in blood pressure) or reduced oxygenation (SpO2 <85%). Postmenstrual age influenced the incidence and thresholds for intervention. Risk of critical events was increased by prior neonatal medical conditions, congenital anomalies, or both (relative risk [RR]=1.16; 95% confidence interval [CI], 1.04–1.28) and in those requiring preoperative intensive support (RR=1.27; 95% CI, 1.15–1.41). Additional complications occurred in 16.3% of patients by 30 days, and overall 90-day mortality was 3.2% (95% CI, 2.7–3.7%). Co-occurrence of intraoperative hypotension, hypoxaemia, and anaemia was associated with increased risk of morbidity (RR=3.56; 95% CI, 1.64–7.71) and mortality (RR=19.80; 95% CI, 5.87–66.7). CONCLUSIONS: Variability in physiological thresholds that triggered an intervention, and the impact of poor tissue oxygenation on patient's outcome, highlight the need for more standardised perioperative management guidelines for neonates and infants