Multidisciplinary consensus on inhaled therapy in asthma

Altres ajuts: Mundipharma Pharmaceuticals SL.Background: Asthma is managed by health professionals from different specialties. We aim to reach a consensus on the optimal use of inhaled therapy and the initial steps of asthma treatment, taking into account the opinions of the involved specialists. Methods: A modified Delphi approach was used. A scientific committee provided 52 controversial statements, which were submitted to primary care physicians, allergists, and pulmonologists. Discrepancies among specialties were evaluated. Results: A total of 209 specialists completed the questionnaire (20.2 ± 9.3 years of asthma management experience). A consensus was reached on 37 statements (71.1%), discrepancies among specialties were found in 14. The most recommended maintenance treatment for mild persistent asthma in adults/adolescents was low-dose-inhaled corticosteroids daily. MART (Maintenance and Reliever Therapy) was recommended as salvage treatment for moderate persistent asthma. Panelists agreed on the most frequent critical errors with pressurized Metered-Dose Inhalers or Dry-Powder Inhalers, and considered that Breath-Actuated Inhalers are a suitable option for all patients with the ability to inhale voluntarily. Conclusions: The experts endorse the main guidelines recommendations; however, do not fully agree on recent GINA recommendations about the treatment of the initial steps of the disease. The experts value positively the differential characteristics of BAI over other devices

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

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 low–middle-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 ‘single-use’ 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 low–middle-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 high– and low–middle–income countries

Inventario de experiencias en duelo (IED): adaptación al castellano, fiabilidad y validez

ObjetivoAdaptar al castellano el Inventario de Experiencias de Duelo (IED) de Catherine Sanders et al (1977) y estudiar su fiabilidad y validez.DiseñoEn dos fases: a) adaptación transcultural de un cuestionario, y b) estudio transversal con grupo control.EmplazamientoEquipos de atención primaria de Vizcaya.ParticipantesUn total de 147 personas que habían enviudado entre los 3 meses y 3 años anteriores al estudio y 36 que no habían perdido a ningún familiar directo en los 5 años previos.Mediciones y resultados principalesEl IED en inglés americano fue traducido, retrotraducido y finalmente revisado por Sanders y sus colaboradores, quienes valoraron la versión adaptada al castellano como equivalente al original. Fiabilidad: la consistencia interna de cada una de las escalas de duelo del IED (alfa de Cronbach) fue de 0,43-0,85. Validez factorial: el primer factor del IED adaptado resultó semejante al del original (desesperanza, somatización, enfado, culpa, despersonalización y aislamiento social). Validez discriminante: todas las escalas de duelo del IED, excepto la de ansiedad ante la muerte, discriminaron (p < 0,05) entre dolientes y no dolientes. Validez por hipótesis: las escalas del IED mostraron diferencias (p < 0,05) entre dolientes según sexo, edad, lugar del fallecimiento del cónyuge y tiempo transcurrido desde la muerte. Validez convergente: todas las escalas de duelo del IED correlacionaron positivamente (p < 0,05) con las del Inventario Texas Revisado de Duelo.ConclusionesEl IED adaptado al castellano es equivalente al original y tiene una fiabilidad y validez similar.ObjectiveTo adapt to Castilian the Inventory of Experiences of Grief (IEG) of Catherine Sanders et al. (1977) and study its reliability and validity.DesignIn two stages: cross-cultural adaptation of a questionnaire and cross-sectional study with control group.SettingPrimary care teams in Vizcaya.Participants147 people bereaved in the period between 3 months and 3 years before the study, and 36 who had lost no direct family member in the previous 5 years.Measurements and main resultsThe IEG in American English was translated, back-translated and finally reviewed by Sanders and her colleagues, whose valuation was that the Castilian version was the same as the original. Reliability: the internal consistency of each of the scales of grief on the IEG (Cronbach's alpha) ran from 0.43 to 0.85. Factor validity: the first IEG factor adapted was similar to the original one (despair, somatization, anger, blame, depersonalisation and social isolation). Discriminating validity: all the grief scales on the IEG, except anxiety in face of death, discriminated (p < 0.05) between grieving and not grieving. Validity by hypothesis: the IEG scales showed differences (p < 0.05) between the bereaved according to sex, age, place of death of the spouse and time elapsed since death. Convergent validity: all the IEG grief scales correlated positively (p < 0.05) with the scales in the Texas Revised Inventory of Grief.ConclusionsThe IEG adapted to Castilian is equivalent to the original and has similar reliability and validity

Transverse meromelia in all four limbs with characteristic facies associated with cocaine abuse in the first trimester of pregnancy

Background. The epidemiological and demographic transition in Mexico demonstrates the frequency of health-related conditions related to illegal drug use in women of childbearing age. Maternal abuse of cocaine during pregnancy is associated with teratogenic effects in the embryo affecting chiefly brain, heart, urogenital tract and extremities, with serious consequences affecting function and/or quality of life of the newborns. Case report. We present the case of a 3-day-old male who presented transverse meromelia in all four limbs with characteristic facies. Parents reported consumption of cocaine. The mother reported consuming cocaine prior to and during the first trimester of pregnancy and self-report was verified along with toxicological urine testing. Conclusions. Studies associated with consumption of teratogenic agents are important to carry out in order to expand scientific knowledge and to establish measures of prevention and treatment of these pathologies