198 research outputs found

    Efectivitat de les ones de xoc focals extracorp貌ries en el tractament de la pseudoartrosi: informe de resposta r脿pida

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    Ones de xoc focals extracorp貌ries; Pseudoartrosi; TractamentOndas de choque focales extracorp贸reas; Pseudoartrosis; TratamientoExtracorporeal focal shock waves; Pseudoarthrosis; TreatmentAvaluaci贸 de l鈥檈fectivitat de les ones de xoc focals extracorp貌ries en el tractament de la pseudoartrosi a qualsevol localitzaci贸

    Artificial intelligence for the detection of colorectal precancerous lesions in colonoscopy

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    Inteligencia artificial; Lesiones precancerosas colorrectales; ColonoscopiaIntel路lig猫ncia artificial; Lesions precanceroses colorectals; Colonosc貌piaArtificial intelligence; Colorectal precancerous lesions; ColonoscopyEl sistema GI Genius鈩 es un dispositivo de inteligencia artificial que funciona como apoyo a la detecci贸n y caracterizaci贸n de lesiones precancerosas y ayuda al diagn贸stico precoz del c谩ncer colorrectal v铆a la utilizaci贸n de marcadores visuales. Este sistema de apoyo funciona como un complemento para el endoscopista durante la colonoscopia, resaltando las regiones con caracter铆sticas visuales compatibles con diferentes tipos de alteraciones de la mucosa, como p贸lipos colorrectales de todos los tama帽os, formas y morfolog铆a, as铆 como la caracterizaci贸n en adenoma o no adenoma

    Estimulaci贸n de la m茅dula espinal en dolor neurop谩tico refractario en adultos: evaluaci贸n de la eficacia, efectividad, seguridad y eficiencia en la neuropat铆a diab茅tica dolorosa y los s铆ndromes de la cirug铆a fallida de columna y de dolor regional complejo

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    Medul路la espinal; Dolor neurop脿tic; Estimulaci贸 el猫ctricaM茅dula espinal; Dolor neurop谩tico; Estimulaci贸n el茅ctricaSpinal cord; Neuropathic pain; Electrical stimulationAquest informe t茅 com a objectiu avaluar la seguretat, l鈥檈fic脿cia/efectivitat i el cost-efectivitat de la SCS en adults per al tractament del dolor neurop脿tic refractari associat a la neuropatia diab猫tica dolorosa (NDD) i a les s铆ndromes de fallida de la cirurgia d鈥檈squena (FBSS per les seves sigles en angl猫s, failed back surgery syndrome) i de dolor regional complex (CRPS per les seves sigles en angl猫s, complex regional pain syndrome) com a t猫cnica coadjuvant i en comparaci贸 amb els tractaments convencionals.Este informe tiene el objectivo de evaluar la seguridad, la eficacia/efectividad y el coste-efectividad de la SCS en adultos para el tratamiento del dolor neurop谩tico refractario asociado a la neuropat铆a diab茅tica dolorosa (NDD) y a los s铆ndromes de la cirug铆a fallida de columna (FBSS por sus siglas en ingl茅s, failed back surgery syndrome) y de dolor regional complejo (CRPS por sus siglas en ingl茅s, complex regional pain syndrome) como t茅cnica coadyuvante y en comparaci贸n con los tratamientos convencionales.The aim of this HTA report is to evaluate the safety, efficacy/effectiveness and cost-effectiveness of SCS in adults to treat refractory neuropathic pain associated with painful diabetic neuropathy (PDN, NDD in Spanish), failed back surgery syndrome (FBSS), and complex regional pain syndrome (CRPS) as an adjuvant technique and in comparison with conventional treatments

    Radiocirug铆a estereot谩ctica para el tratamiento de la epilepsia, el temblor esencial, la enfermedad de Parkinson, la neuralgia del glosofar铆ngeo y del trig茅mino: s铆ntesis de su eficacia, efectividad, seguridad y eficiencia

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    Radiocirugia estereot脿ctica; Tractament; Efic脿ciaRadiocirug铆a estereot谩ctica; Tratamiento; EficaciaStereotactic radiosurgery; Treatment; EffectivenessEl objetivo principal del informe es evaluar la seguridad, la eficacia, la efectividad cl铆nica y el costeefectividad de la radiocirug铆a estereot谩ctica frente al tratamiento habitual para la epilepsia, el temblor esencial, el temblor asociado a la enfermedad de Parkinson y las neuralgias del glosofar铆ngeo y del trig茅mino. Se consideran cuando estas patolog铆as son farmacorresistentes/refractarias.The aim of this report is to evaluate the safety, efficacy, clinical effectiveness and cost-effectiveness of stereotactic radiosurgery versus standard treatment for epilepsy, essential tremor, tremor associated with Parkinson鈥檚 disease, and glossopharyngeal and trigeminal neuralgias, when these pathologies are drug-resistant/refractoryL鈥檕bjectiu d鈥檃quest informe 茅s avaluar la seguretat, l鈥檈fic脿cia, l鈥檈fectivitat cl铆nica i el cost-efectivitat de la radiocirurgia estereot脿ctica davant del tractament habitual per a l鈥檈pil猫psia, el tremolor essencial, el tremolor associat a la malaltia de Parkinson i les neur脿lgies del glossofaringi i del trigemin, quan aquestes patologies s贸n farmacoresistents/refract脿rie

    Process evaluation of a complex workplace intervention to prevent musculoskeletal pain in nursing staff: results from INTEVAL_Spain.

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    Background INTEVAL_Spain was a complex workplace intervention to prevent and manage musculoskeletal pain among nursing staff. Process evaluations can be especially useful for complex and multifaceted interventions through identifying the success or failure factors of an intervention to improve the intervention implementation. Objectives This study performed a process evaluation of INTEVAL_Spain and aimed to examine whether the intervention was conducted according to the protocol, to investigate the fulfilment of expectations and the satisfaction of workers. Methods The intervention was a two-armed cluster randomized controlled trial and lasted 1 year. The process evaluation included quantitative and qualitative methods. Quantitative methods were used to address the indicators of Steckler and Linnan's framework. Data on recruitment was collected through a baseline questionnaire for the intervention and the control group. Reach and dose received were collected through participation sheets, dose delivered and fidelity through internal registries, and fulfilment of expectations and satisfaction were collected with two questions at 12-months follow-up. Qualitative methods were used for a content analysis of discussion groups at the end of the intervention led by an external moderator to explore satisfaction and recommendations. The general communication and activities were discussed, and final recommendations were agreed on. Data were synthesized and results were reported thematically. Results The study was performed in two Spanish hospitals during 2016-2017 and 257 workers participated. Recruitment was 62 and 51% for the intervention and the control group, respectively. The reach of the activities ranged from 96% for participatory ergonomics to 5% for healthy diet. The number of sessions offered ranged from 60 sessions for Nordic walking to one session for healthy diet. Fidelity of workers ranged from 100% for healthy diet and 79% for participatory ergonomics, to 42 and 39% for Nordic walking and case management, respectively. Lowest fidelity of providers was 75% for case management and 82% for Nordic walking. Fulfilment of expectations and satisfaction ranged from 6.6/10 and 7.6/10, respectively, for case management to 10/10 together for the healthy diet session. Discussion groups revealed several limitations for most of the activities, mainly focused on a lack of communication between the Champion (coordinator) and the workers. Conclusions This process evaluation showed that the implementation of INTEVAL_Spain was predominantly carried out as intended. Process indicators differed depending on the activity. Several recommendations to improve the intervention implementation process are proposed

    Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

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    BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25路4% (95% CI 19路1-31路8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7路8%, 4路8-10路7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27路2%, 17路6-36路8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33路0%, 18路3-47路6; I2 =98%) than in other migrant groups (6路6%, 1路8-11路3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33路1%, 11路1-55路1; I2 =96%) than in migrants in hospitals (24路3%, 16路1-32路6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

    Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study