11 research outputs found
Tratamiento de la deficiencia androgénica del enfermo dializado con suplementos de testosterona. Resultados preliminares
Occurrence of Hepatitis E Virus in Pigs and Pork Cuts and Organs at the Time of Slaughter, Spain, 2017
Zoonotic hepatitis E, mainly caused by hepatitis E virus (HEV) genotype (gt) 3, is a foodborne disease that has emerged in Europe in recent decades. The main animal reservoir for genotype 3 is domestic pigs. Pig liver and liver derivates are considered the major risk products, and studies focused on the presence of HEV in pig muscles are scarce. The objective of the present study was to evaluate the presence of HEV in different organs and tissues of 45 apparently healthy pigs from nine Spanish slaughterhouses (50% national production) that could enter into the food supply chain. Anti-HEV antibodies were evaluated in serum by an ELISA test. Ten samples from each animal were analyzed for the presence of HEV RNA by reverse transcription realtime PCR (RT-qPCR). The overall seroprevalence obtained was 73.3% (33/45). From the 450 samples analyzed, a total of 26 RT-qPCR positive samples were identified in the liver (7/45), feces (6/45), kidney (5/45), heart (4/45), serum (3/45), and diaphragm (1/45). This is the first report on detection of HEV RNA in kidney and heart samples of naturally infected pigs. HEV RNA detection was negative for rib, bacon, lean ham, and loin samples. These findings indicate that pig meat could be considered as a low risk material for foodborne HEV infection.Fil: GarcĂa, Nerea. Universidad Complutense de Madrid; EspañaFil: HernĂĄndez, Marta. Universidad de Burgos; EspañaFil: Gutierrez Boada, Maialen. Universidad de Burgos; EspañaFil: Valero, Antonio. Universidad de CĂłrdoba; EspañaFil: Navarro, Alejandro. Universidad Complutense de Madrid; EspañaFil: Muñoz Chimeno, Milagros. Universidad Carlos III de Madrid. Instituto de Salud; EspañaFil: FernĂĄndez Manzano, Alvaro. Universidad Complutense de Madrid; EspañaFil: Escobar, Franco Matias. Universidad Nacional de RĂo Cuarto. Facultad de Ciencias Exactas, FisicoquĂmicas y Naturales. Departamento de MicrobiologĂa e InmunologĂa; Argentina. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas. Centro CientĂfico TecnolĂłgico Conicet - CĂłrdoba; ArgentinaFil: MartĂnez, Irene. Universidad Complutense de Madrid; EspañaFil: BĂĄrcena, Carmen. Universidad Complutense de Madrid; EspañaFil: GonzĂĄlez, Sergio. Universidad Complutense de Madrid; EspañaFil: AvellĂłn, Ana. Universidad Carlos III de Madrid. Instituto de Salud; EspañaFil: Eiros, Jose M.. Hospital Universitario Rio Hortega; EspañaFil: Fongaro, Gislaine. Universidade Federal de Santa Catarina; BrasilFil: DomĂnguez, Lucas. Universidad Complutense de Madrid; EspañaFil: Goyache, JoaquĂn. Universidad Complutense de Madrid; EspañaFil: RodrĂguez LĂĄzaro, David. Universidad de Burgos; Españ
Perfil clĂnico de los pacientes tratados con evolocumab en unidades hospitalarias de nefrologĂa en España
Describir las caracterĂsticas clĂnicas de los pacientes tratados con evolocumab, las razones del inicio de la terapia y los efectos del tratamiento en la fase inicial de disponibilidad de evolocumab en las unidades de nefrologĂa de España
Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)
This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (â„3 chronic diseases) and polypharmacy (â„5 drugs prescribed in â„3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe
Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries
Abstract
Background
Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres.
Methods
This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and lowâmiddle-income countries.
Results
In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of âsingle-useâ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for lowâmiddle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia.
Conclusion
This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both highâ and lowâmiddleâincome countries
GuĂa ClĂnica Española del Acceso Vascular para HemodiĂĄlisis
El acceso vascular para hemodiĂĄlisis es esencial para el enfermo renal tanto por su
morbimortalidad asociada como por su repercusiĂłn en la calidad de vida. El proceso que
va desde la creaciĂłn y mantenimiento del acceso vascular hasta el tratamiento de sus
complicaciones constituye un reto para la toma de decisiones debido a la complejidad de la
patologĂa existente y a la diversidad de especialidades involucradas. Con el fin de conseguir
un abordaje consensuado, el Grupo Español Multidisciplinar del Acceso Vascular (GEMAV),
que incluye expertos de las cinco sociedades cientĂficas implicadas (nefrologĂa [S.E.N.], cirugĂa
vascular [SEACV], radiologĂa vascular e intervencionista [SERAM-SERVEI], enfermedades
infecciosas [SEIMC] y enfermerĂa nefrolĂłgica [SEDEN]), con el soporte metodolĂłgico del Centro
Cochrane Iberoamericano, ha realizado una actualizaciĂłn de la GuĂa del Acceso Vascular
para HemodiĂĄlisis publicada en 2005. Esta guĂa mantiene una estructura similar, revisando
la evidencia sin renunciar a la vertiente docente, pero se aportan como novedades, por un
lado, la metodologĂa en su elaboraciĂłn, siguiendo las directrices del sistema GRADE con
el objetivo de traducir esta revisiĂłn sistemĂĄtica de la evidencia en recomendaciones que
faciliten la toma de decisiones en la prĂĄctica clĂnica habitual y, por otro, el establecimiento
de indicadores de calidad que permitan monitorizar la calidad asistencial.Vascular access for haemodialysis is key in renal patients both due to its associated morbidity
and mortality and due to its impact on quality of life. The process, from the creation and
maintenance of vascular access to the treatment of its complications, represents a challenge
when it comes to decision-making, due to the complexity of the existing disease and the
diversity of the specialities involved. With a view to finding a common approach, the Spanish
Multidisciplinary Group on Vascular Access (GEMAV), which includes experts from the five
scientific societies involved (nephrology [S.E.N.], vascular surgery [SEACV], vascular and
interventional radiology [SERAM-SERVEI], infectious diseases [SEIMC] and nephrology nursing
[SEDEN]), along with the methodological support of the Cochrane Center, has updated the
Guidelines on Vascular Access for Haemodialysis, published in 2005. These guidelines maintain
a similar structure, in that they review the evidence without compromising the educational
aspects. However, on one hand, they provide an update to methodology development following
the guidelines of the GRADE system in order to translate this systematic review of evidence
into recommendations that facilitate decision-making in routine clinical practice, and, on
the other hand, the guidelines establish quality indicators which make it possible to monitor
the quality of healthcare
GuĂa ClĂnica Española del Acceso Vascular para HemodiĂĄlisis
El acceso vascular para hemodiĂĄlisis es esencial para el enfermo renal tanto por su
morbimortalidad asociada como por su repercusiĂłn en la calidad de vida. El proceso que
va desde la creaciĂłn y mantenimiento del acceso vascular hasta el tratamiento de sus
complicaciones constituye un reto para la toma de decisiones debido a la complejidad de la
patologĂa existente y a la diversidad de especialidades involucradas. Con el fin de conseguir
un abordaje consensuado, el Grupo Español Multidisciplinar del Acceso Vascular (GEMAV),
que incluye expertos de las cinco sociedades cientĂficas implicadas (nefrologĂa [S.E.N.], cirugĂa
vascular [SEACV], radiologĂa vascular e intervencionista [SERAM-SERVEI], enfermedades
infecciosas [SEIMC] y enfermerĂa nefrolĂłgica [SEDEN]), con el soporte metodolĂłgico del Centro
Cochrane Iberoamericano, ha realizado una actualizaciĂłn de la GuĂa del Acceso Vascular
para HemodiĂĄlisis publicada en 2005. Esta guĂa mantiene una estructura similar, revisando
la evidencia sin renunciar a la vertiente docente, pero se aportan como novedades, por un
lado, la metodologĂa en su elaboraciĂłn, siguiendo las directrices del sistema GRADE con
el objetivo de traducir esta revisiĂłn sistemĂĄtica de la evidencia en recomendaciones que
faciliten la toma de decisiones en la prĂĄctica clĂnica habitual y, por otro, el establecimiento
de indicadores de calidad que permitan monitorizar la calidad asistencial.Vascular access for haemodialysis is key in renal patients both due to its associated morbidity
and mortality and due to its impact on quality of life. The process, from the creation and
maintenance of vascular access to the treatment of its complications, represents a challenge
when it comes to decision-making, due to the complexity of the existing disease and the
diversity of the specialities involved. With a view to finding a common approach, the Spanish
Multidisciplinary Group on Vascular Access (GEMAV), which includes experts from the five
scientific societies involved (nephrology [S.E.N.], vascular surgery [SEACV], vascular and
interventional radiology [SERAM-SERVEI], infectious diseases [SEIMC] and nephrology nursing
[SEDEN]), along with the methodological support of the Cochrane Center, has updated the
Guidelines on Vascular Access for Haemodialysis, published in 2005. These guidelines maintain
a similar structure, in that they review the evidence without compromising the educational
aspects. However, on one hand, they provide an update to methodology development following
the guidelines of the GRADE system in order to translate this systematic review of evidence
into recommendations that facilitate decision-making in routine clinical practice, and, on
the other hand, the guidelines establish quality indicators which make it possible to monitor
the quality of healthcare
Role of Active Site Histidines in the Two Half-Reactions of the Aryl-Alcohol Oxidase Catalytic Cycle
Children living with HIV in Europe: do migrants have worse treatment outcomes?
International audienceTo assess the effect of migrant status on treatment outcomes among children living with HIV in Europe