Efectivitat de les ones de xoc focals extracorpòries en el tractament de la pseudoartrosi: informe de resposta ràpida

Ones de xoc focals extracorpòries; Pseudoartrosi; TractamentOndas de choque focales extracorpóreas; Pseudoartrosis; TratamientoExtracorporeal focal shock waves; Pseudoarthrosis; TreatmentAvaluació de l’efectivitat de les ones de xoc focals extracorpòries en el tractament de la pseudoartrosi a qualsevol localització

Artificial intelligence for the detection of colorectal precancerous lesions in colonoscopy

Inteligencia artificial; Lesiones precancerosas colorrectales; ColonoscopiaIntel·ligència artificial; Lesions precanceroses colorectals; ColonoscòpiaArtificial intelligence; Colorectal precancerous lesions; ColonoscopyEl sistema GI Genius™ es un dispositivo de inteligencia artificial que funciona como apoyo a la detección y caracterización de lesiones precancerosas y ayuda al diagnóstico precoz del cáncer colorrectal vía la utilización de marcadores visuales. Este sistema de apoyo funciona como un complemento para el endoscopista durante la colonoscopia, resaltando las regiones con características visuales compatibles con diferentes tipos de alteraciones de la mucosa, como pólipos colorrectales de todos los tamaños, formas y morfología, así como la caracterización en adenoma o no adenoma

Estimulación de la médula espinal en dolor neuropático refractario en adultos: evaluación de la eficacia, efectividad, seguridad y eficiencia en la neuropatía diabética dolorosa y los síndromes de la cirugía fallida de columna y de dolor regional complejo

Medul·la espinal; Dolor neuropàtic; Estimulació elèctricaMédula espinal; Dolor neuropático; Estimulación eléctricaSpinal cord; Neuropathic pain; Electrical stimulationAquest informe té com a objectiu avaluar la seguretat, l’eficàcia/efectivitat i el cost-efectivitat de la SCS en adults per al tractament del dolor neuropàtic refractari associat a la neuropatia diabètica dolorosa (NDD) i a les síndromes de fallida de la cirurgia d’esquena (FBSS per les seves sigles en anglès, failed back surgery syndrome) i de dolor regional complex (CRPS per les seves sigles en anglès, complex regional pain syndrome) com a tècnica coadjuvant i en comparació 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 neuropático refractario asociado a la neuropatía diabética dolorosa (NDD) y a los síndromes de la cirugía fallida de columna (FBSS por sus siglas en inglés, failed back surgery syndrome) y de dolor regional complejo (CRPS por sus siglas en inglés, complex regional pain syndrome) como técnica coadyuvante y en comparación 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

Radiocirugía estereotáctica para el tratamiento de la epilepsia, el temblor esencial, la enfermedad de Parkinson, la neuralgia del glosofaríngeo y del trigémino: síntesis de su eficacia, efectividad, seguridad y eficiencia

Radiocirugia estereotàctica; Tractament; EficàciaRadiocirugía estereotáctica; Tratamiento; EficaciaStereotactic radiosurgery; Treatment; EffectivenessEl objetivo principal del informe es evaluar la seguridad, la eficacia, la efectividad clínica y el costeefectividad de la radiocirugía estereotáctica frente al tratamiento habitual para la epilepsia, el temblor esencial, el temblor asociado a la enfermedad de Parkinson y las neuralgias del glosofaríngeo y del trigémino. Se consideran cuando estas patologías 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’s disease, and glossopharyngeal and trigeminal neuralgias, when these pathologies are drug-resistant/refractoryL’objectiu d’aquest informe és avaluar la seguretat, l’eficàcia, l’efectivitat clínica i el cost-efectivitat de la radiocirurgia estereotàctica davant del tractament habitual per a l’epilèpsia, el tremolor essencial, el tremolor associat a la malaltia de Parkinson i les neuràlgies del glossofaringi i del trigemin, quan aquestes patologies són farmacoresistents/refractàrie

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

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

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 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; 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

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

CMS physics technical design report : Addendum on high density QCD with heavy ions

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Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe