Oral direct anticoagulants in the treatment of nonvalvular atrial fibrillation. Results of the daily clinical practice.

Atrial fibrillation (AF) is the most common arrhythmia. It leads to significant morbidity and mortality. The new oral anticoagulants (NOAC) represent an improvement compared with standard treatment (vitamin K antagonists (AVK)) in the prevention of thromboembolic complications in patients with non-valvular AF.N

Una década de investigación documental sobre cienciometría en España: análisis de los artículos de la base de datos ISOC (2000-2009)

The primary purpose of this study is to define the evolution of papers on Scientometrics in Spain during the period 2000-2009 from the Information Science perspective as applied to scientific research. The analysis focuses on the areas of Social Sciences and Humanities, using records selected from the ISOC database. The results are analyzed from different perspectives: authors, organizations, geographic areas, languages, journals, classifications and descriptors. Finally, we discuss possible ways for expanding research and then highlight some conclusions regarding scientific documentation in Spain during the first decade of the 21st century.El propósito fundamental del presente trabajo es definir la evolución de los artículos sobre cienciometría en España durante el período 2000-2009 desde la perspectiva de la documentación aplicada a la investigación científica. El análisis se centra en las áreas de las ciencias sociales y de las humanidades, a partir de los registros seleccionados de la base de datos ISOC. En los resultados, se analizan los artículos desde diferentes perspectivas: autores, organizaciones, áreas geográficas, idiomas, revistas, clasificaciones y descriptores. Finalmente, se comentan las posibles vías de ampliación de la investigación y se destacan algunas conclusiones sobre la documentación científica en España durante la primera década del siglo XXI

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

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 (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥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

Cardiac, renal, and neurological benefits of preoperative levosimendan administration in patients with right ventricular dysfunction and pulmonary hypertension undergoing cardiac surgery: evaluation with two biomarkers neutrophil gelatinase-associated lipocalin and neuronal enolase

José Luis Guerrero-Orriach,1 Daniel Ariza-Villanueva,1 Ana Florez-Vela,1 Lourdes Garrido-Sánchez,2,3 María Isabel Moreno-Cortés,1 Manuel Galán-Ortega,1 Alicia Ramírez-Fernández,1 Juan Alcaide Torres,3 Concepción Santiago Fernandez,3 Isabel Navarro Arce,1 José María Melero-Tejedor,4 Manuel Rubio-Navarro,1 José Cruz-Mañas1 1Department of Cardio-Anaesthesiology, University Hospital Virgen de la Victoria, Málaga, Spain; 2CIBER Fisiología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Málaga, Spain; 3Department of Nutrition and Endocrinology, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), University Hospital Virgen de la Victoria, Málaga, Spain; 4Department of Cardiovascular Surgery, University Hospital Virgen de la Victoria, Málaga, Spain Purpose: To evaluate if the preoperative administration of levosimendan in patients with right ventricular (RV) dysfunction, pulmonary hypertension, and high perioperative risk would improve cardiac function and would also have a protective effect on renal and neurological functions, assessed using two biomarkers neutrophil gelatinase-associated lipocalin (N-GAL) and neuronal enolase. Methods: This is an observational study. Twenty-seven high-risk cardiac patients with RV dysfunction and pulmonary hypertension, scheduled for cardiac valve surgery, were prospectively followed after preoperative administration of levosimendan. Levosimendan was administered preoperatively on the day before surgery. All patients were considered high risk of cardiac and perioperative renal complications. Cardiac function was assessed by echocardiography, renal function by urinary N-GAL levels, and the acute kidney injury scale. Neuronal damage was assessed by neuron-specific enolase levels. Results: After surgery, no significant variations were found in mean and SE levels of N-GAL (14.31 [28.34] ng/mL vs 13.41 [38.24] ng/mL), neuron-specific enolase (5.40 [0.41] ng/mL vs 4.32 [0.61] ng/mL), or mean ± SD creatinine (1.06±0.24 mg/dL vs 1.25±0.37 mg/dL at 48 hours). RV dilatation decreased from 4.23±0.7 mm to 3.45±0.6 mm and pulmonary artery pressure from 58±18 mmHg to 42±19 mmHg at 48 hours. Conclusion: Preoperative administration of levosimendan has shown a protective role against cardiac, renal, and neurological damage in patients with a high risk of multiple organ dysfunctions undergoing cardiac surgery. Keywords: levosimendan, preoperative, kidney, brain, acute renal failur

Regional Foreign Direct Investment in Manufacturing. Do Agglomeration Economies Matter?

Pelegrin A. and Bolance C. Regional foreign direct investment in manufacturing. Do agglomeration economies matter?, Regional Studies. This paper examines the role played by agglomeration economies as location determinants of regional foreign direct investment (FDI) in manufacturing. The analysis reveals that FDI location is dependent on specific industry traits and that agglomeration economies appear as the strongest pull factors. The model, estimated with panel data, finds evidence, first, that industries with a high level of linkages are attracted to regions with high manufacturing activity, and, second, that locations which accumulate research and development (R&D) activities attract chemical industries. Finally, cost-oriented industries do not value agglomeration economies and their localization emerges as a result of endowment reasons. [image omitted] Pelegrin A. et Bolance C. L'investissement direct etranger regional dans l'industrie - Les economies d'agglomeration, ont-elles de l'importance? Regional Studies. Cet article cherche a examiner le role que jouent les economies d'agglomeration dans la determination de la localisation de l'investissement direct etranger regional industrielle. L'analyse laisse voir que la localisation de l'investissement direct etranger depend des caracteristiques particulieres de l'industrie et que les economies d'agglomeration s'averent les forces motrices les plus puissantes. Estime a partir des donnees provenant d'une enquete a echantillon constant, le modele indique, primo, que les industries qui jouissent d'importantes liaisons se dirigent vers les regions dont l'activite industrielle est forte et, secundo, que les industries chimiques s'installent dans les zones ou s'agglomerent les activites de R et D. Pour conclure, les industries qui mettent l'accent sur les couts n'evaluent pas les economies d'agglomeration, et leur localisation s'explique par des caracteristiques particulieres. Investissement direct etranger Economies d'agglomeration Localisation de l'industrie regionale Caracteristiques industrielles Donnees par enquete a echantillon constant Pelegrin A. und Bolance C. Regionale auslandische Direktinvestitionen in produzierende Betriebe: Spielen Agglomerationswirtschaften eine Rolle? Regional Studies. In diesem Beitrag wird untersucht, welche Rolle Agglomerationswirtschaften als Standortdeterminanten fur regionale auslandische Direktinvestitionen in produzierende Betriebe spielen. Aus der Analyse geht hervor, dass der Standort fur auslandische Direktinvestitionen von spezifischen Branchenmerkmalen abhangt und dass von Agglomerationswirtschaften die starkste Anziehungskraft auszugehen scheint. Aus diesem Modell, das auf Schatzungen anhand von Paneldaten beruht, gehen Belege hervor, dass erstens hochgradig verknupfte Branchen von Regionen mit ausgepragter Produktionstatigkeit angezogen werden, und dass zweitens Standorte, in denen sich F&E-Aktivitaten konzentrieren, Chemiebetriebe anziehen. Kostenorientierte Branchen schliesslich legen keinen Wert auf Agglomerationswirtschaften; hier richtet sich die Standortwahl nach Aspekten der Ausstattung. Auslandische Direktinvestitionen Agglomerationswirtschaften Regionale Produktionsstandorte Branchenmerkmale Paneldaten Pelegrin A. y Bolance C. Inversion directa extranjera regional en manufacturacion �Importan las economias de aglomeracion? Regional Studies. En este articulo examinamos el rol desempenado por las economias de aglomeracion como determinantes de ubicacion de la inversion directa extranjera regional en manufacturacion. El analisis indica que la ubicacion de la inversion directa extranjera depende de particularidades especificas en la industria y que las economias de aglomeracion aparecen como los factores mas solidos de atraccion. Con el modelo, segun una estimacion de datos de panel, se demuestra primero que las industrias con un alto nivel de vinculos se ven atraidos por regiones con una alta actividad de manufacturacion y segundo, que las ubicaciones en las que se acumulan las actividades de I + D atraen a las industrias quimicas. Finalmente, las industrias basadas en el coste no valoran las economias de aglomeracion y su ubicacion depende de la dotacion de la region. Inversion directa extranjera Economias de aglomeracion Ubicacion de manufacturacion regional Particularidades de la industria Datos de panelR12, F21, F23,