RESUMEN
BACKGROUND/AIMS: Mean survival in hepatocellular carcinoma remains low. Many efforts have been done during the last years through screening, diagnosis and treatment to improve the results. The aim of this work is to present the experience of our hospital multidisciplinary group during the first decade of this century. METHODOLOGY: The patients with hepatocellullar carcinoma presented at the multidisciplinary meeting from 1999 to 2009 were prospectively studied. According to the tumor and functional status they were treated through the current available guidelines by transplant, partial hepatectomy, local/regional procedures, systemic or symptomatic treatment. RESULTS: One hundred and forty two patients were studied. Median tumor size was 3 cm. A single tumor was diagnosed in 64.8% of the patients. Eighteen patients had liver resection (6 transplantation and 12 with partial resection), 53 tumors were not treated due to advanced stage or liver dysfunction, and in the remaining patients radiofrequency, ethanol or embolization treatments were used, single or combined. CONCLUSIONS: a multidisciplinary approach of hepatocellular carcinoma in a second level hospital with trained professionals permits a diagnosis in early tumoral and functional stages in the majority of patients, and a variety of possible treatments with adequate survival outcomes.
Asunto(s)
Técnicas de Ablación , Antineoplásicos/uso terapéutico , Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica , Hepatectomía , Neoplasias Hepáticas/terapia , Trasplante de Hígado , Grupo de Atención al Paciente , Anciano , Carcinoma Hepatocelular/etiología , Carcinoma Hepatocelular/patología , Ablación por Catéter , Estudios de Cohortes , Embolización Terapéutica , Femenino , Hepatitis B Crónica/complicaciones , Hepatitis C Crónica/complicaciones , Humanos , Hepatopatías Alcohólicas/complicaciones , Neoplasias Hepáticas/etiología , Neoplasias Hepáticas/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Niacinamida/análogos & derivados , Compuestos de Fenilurea , Estudios Prospectivos , Centros de Atención Secundaria , Sorafenib , Resultado del Tratamiento , Carga TumoralRESUMEN
La elaboración de protocolos y la medida de su cumplimiento mejoran la calidad asistencial. Actividades promovidas por los sistemas de vigilancia de infección nosocomial se deben potenciar y someter a evaluación por afectar al cuidado del paciente, a su calidad de vida y resultados clínicos. La ducha y los enjuagues con clorhexidina forman parte del protocolo de preparación prequirúrgica del paciente y son recomendados en las guías por disminuir la infección de herida quirúrgica y neumonía posquirúrgica. Hemos llevado a cabo un estudio descriptivo transversal de evaluación de la adecuación a estos aspectos del protocolo de preparación requirúrgica en pacientes operados de prótesis de cadera. Se ha encontrado un grado de cumplimiento global del 59%; 88,5% para la ducha con jabón de clorhexidina al menos 24 horas antes de la cirugía y 63% para el colutorio con antiséptico. Estos resultados muestran una necesidad de mejora con medidas correctoras como pueden ser la entrega de normas por escrito y una mayor implicación tanto por parte del personal como del paciente (AU)
Protocols production and the measurement of their compliance are useful to improve health assistance quality. Surveillance infection at hospital is a process to evaluate because it affects to patient care, life quality and clinical results. Shower and rinsing with clorhexidine are part of pre-surgical patient preparation and they are recommended in the guides because they reduce surgical wound infection and post-surgical pneumonia. This study evaluates the compliance and appropriatness of several activities in pre-surgical preparation (shower and oropharyngeal wash with clorhexidine). Transverse study of adaptation to some activities of a protocol of pre-surgical patient preparation in hip replacement. Average comparation is carried out with t student and percentage of protocol adaptation. Global compliance grade was 59%, of which 88,5% was for the shower with clorhexidine with at least 24 hours before surgery and 63% was regarding mouthwash. The use of protocols must be bound to systematic evaluation of its compliance (AU)
Asunto(s)
Humanos , Cuidados Preoperatorios/métodos , Protocolos Clínicos , Adhesión a Directriz/estadística & datos numéricos , Complicaciones Intraoperatorias/prevención & control , /normas , Infección de la Herida Quirúrgica/prevención & control , Evaluación de Resultados de Acciones PreventivasRESUMEN
This work describes and analyses an outbreak of epidemic keratoconjunctivitis which occurred in 2001 and 2002 in a nursing home for the elderly in Leganes (an area of Madrid). This is the first such published case in Spain with these characteristics and this serotype identification. Sociodemographic characteristics, epidemic curve and attack rates are described. Comparisons of the data were carried out using a chi2 test for qualitative variable and t-test for quantitative. Factors associated with the illness are explored by means of contingency tables and logistic regression models. One hundred and two cases were detected, with an attack rate of 36.4% for residents, and 12.9% for workers, not considering spatial or professional differences. The epidemic curve showed an interpersonal transmission pattern. Multivariate analysis identified the following risk factors in the residents: able to wander freely through the building, urinary incontinence and use of shared bathroom. In 34.6% of the conjunctival samples, adenovirus serotype 8 was detected with identical genomic sequence. Establishment of hygienic sanitary guidance adapted for the cleaning of such establishments and contact with residents as well as early diagnosis and good coordination of human and material resources are key factors in the prevention and control of these outbreaks in closed communities.