RESUMEN

BACKGROUND: The link between obesity and adverse cardiovascular events is well-established. With the rising prevalence of metabolic and bariatric surgery (MBS), a greater number of patients undergoing sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) may present with preoperative therapeutic anticoagulation (AC). OBJECTIVES: This study evaluated perioperative outcomes of SG and RYGB in patients on preoperative AC. SETTING: Patients reported to the 2015-2021 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. METHODS: Adults undergoing primary SG or RYGB with and without preoperative anticoagulation (SG-AC or RYGB-AC and non-SG-AC or non-RYGB-AC, respectively) were analyzed from the 2015-2021 MBSAQIP database. Differences in baseline characteristics by AC status for each MBS were adjusted using entropy-balanced weights. Multivariable logistic and linear regressions were developed to analyze the independent association between AC and outcomes of interest. RESULTS: Of 1,178,090 patients included, 72.0% (n = 850,682) had SG and 28.0% (n = 327,408) had RYGB, of which 1.8% (n = 15,021) and 1.9% (n = 6201) had AC, respectively. Compared to non-SG-AC and non-RYGB-AC, both SG-AC and RYGB-AC encountered higher absolute 30-day rates of anastomotic leak, deep vein thrombosis and gastrointestinal bleeding. Following multivariable adjustment, SG-AC was associated with significantly greater odds of adverse cardiovascular events, anastomotic leak, gastrointestinal bleeding, and greater operative length and length of stay. RYGB-AC was associated with higher odds of readmission, unplanned ICU admission, and ED visit. CONCLUSIONS: While preoperative AC may confer distinct outcomes between SG and RYGB, this 7-year study of MBSAQIP demonstrated an overall association with greater postoperative morbidity. Management of MBS patients with preoperative AC requires consideration of thrombohemorrhagic risks.

RESUMEN

La aparición de úlceras por presión (UPP) es una de las complicaciones frecuentes del decúbito prono (DP), debido a la presión prolongada y las fuerzas de cizallamiento. Objetivos: Comparar la incidencia de UPP secundarias a la posición del decúbito prono y describir su localización entre 4 unidades de cuidados intensivos (UCI) de hospitales públicos. Metodología: Estudio observacional descriptivo retrospectivo multicéntrico. La población estuvo formada por pacientes ingresados en la UCI entre febrero de 2020 y mayo 2021, diagnosticados de COVID-19 que precisaron decúbito prono. Las variables estudiadas fueron sociodemográficas, días de ingreso en la UCI, horas totales en DP, prevención de UPP, localización, estadio, frecuencia de cambios posturales, nutrición y aporte de proteínas. La recogida de datos se realizó a través de la historia clínica de las diferentes bases de datos informatizadas de cada hospital. Se realizó análisis descriptivo y asociación entre las variables, utilizando el programa SPSS vs.20.0.Resultados: Ingresaron 574 pacientes por COVID-19, el 43,03% fueron pronados. El 69,6% fueron hombres, la mediana de edad fue 66 (RIC: 55-74) y el IMC de 30,7 (RIC: 27-34,2). La mediana de estancia en la UCI fue de 28 días (RIC: 17-44,2) y la mediana de horas en DP por paciente 48h (RIC: 24-96). La incidencia de aparición de UPP fue del 56,3% y el 76,2% de los pacientes la presentaron; la localización más frecuente fue la frente (74,9%). Existen diferencias significativas entre hospitales en cuanto a la incidencia de UPP (p<0,001), su localización (p=0,000) y la duración media de horas por cada episodio de DP (p=0,001). Conclusiones: La incidencia de UPP secundarias al DP fue muy elevada. Existe gran variabilidad en cuanto a incidencia de UPP entre hospitales, la localización y la duración media de horas por cada episodio de DP.(AU)

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The appearance of pressure ulcers (PU) is one of the frequent complications of prone position (PP), due to prolonged pressure and shear forces. Objectives: To compare the incidence of pressure ulcers secondary to prone position and describe their location among four Intensive Care Units (ICU) of public hospitals. Methods: Multicenter descriptive and retrospective observational study. The population consisted of patients admitted to the ICU between February 2020 and May 2021, diagnosed with Covid-19 who required prone decubitus. The variables studied were sociodemographic, days of admission to the ICU, total hours on PP, PU prevention, location, stage, frequency of postural changes, nutrition and protein intake. Data collection was carried out through the clinical history of the different computerized databases of each hospital. Descriptive analysis and association between variables were performed using SPSS vs.20.0. Results: A total of 574 patients were admitted for Covid-19, 43.03% were pronated. 69.6% were men, median age was 66 (IQR 55-74) and BMI 30.7 (RIC 27-34.2). Median ICU stay was 28 days (IQR 17-44.2), median hours on PD per patient 48h (IQR 24-96). The incidence of PU occurrence was 56.3%, 76.2% of patients presented a PU, the most frequent location was the forehead (74.9%). There were significant differences between hospitals in terms of PU incidence (p=0.002), location (p<0.001) and median duration of hours per PD episode (p=0.001). Conclusions: The incidence of pressure ulcers due to the prone position was very high. There is great variability in the incidence of pressure ulcers between hospitals, location and average duration of hours per episode of prone position.(AU)

Asunto(s)

Humanos , Masculino , Femenino , Úlcera por Presión , Posición Prona , Cuidados Críticos , /enfermería , Estudios Retrospectivos , Enfermería , Atención de Enfermería

RESUMEN

The appearance of pressure ulcers (PU) is one of the frequent complications of prone position (PP), due to prolonged pressure and shear forces. Objectives: To compare the incidence of pressure ulcers secondary to prone position and describe their location among four Intensive Care Units (ICU) of public hospitals. Methods: Multicenter descriptive and retrospective observational study. The population consisted of patients admitted to the ICU between February 2020 and May 2021, diagnosed with Covid-19 who required prone decubitus. The variables studied were sociodemographic, days of admission to the ICU, total hours on PP, PU prevention, location, stage, frequency of postural changes, nutrition and protein intake. Data collection was carried out through the clinical history of the different computerized databases of each hospital. Descriptive analysis and association between variables were performed using SPSS vs.20.0. Results: A total of 574 patients were admitted for Covid-19, 43.03% were pronated. 69.6% were men, median age was 66 (IQR 55-74) and BMI 30.7 (RIC 27-34.2). Median ICU stay was 28 days (IQR 17-44.2), median hours on PD per patient 48 h (IQR 24-96). The incidence of PU occurrence was 56.3%, 76.2% of patients presented a PU, the most frequent location was the forehead (74.9%). There were significant differences between hospitals in terms of PU incidence (p = 0.002), location (p < 0.001) and median duration of hours per PD episode (p = 0.001). Conclusions: The incidence of pressure ulcers due to the prone position was very high. There is great variability in the incidence of pressure ulcers between hospitals, location and average duration of hours per episode of prone position.

RESUMEN

The appearance of pressure ulcers (PU) is one of the frequent complications of prone position (PP), due to prolonged pressure and shear forces. OBJECTIVES: To compare the incidence of pressure ulcers secondary to prone position and describe their location among four Intensive Care Units (ICU) of public hospitals. METHODS: Multicenter descriptive and retrospective observational study. The population consisted of patients admitted to the ICU between February 2020 and May 2021, diagnosed with Covid-19 who required prone decubitus. The variables studied were sociodemographic, days of admission to the ICU, total hours on PP, PU prevention, location, stage, frequency of postural changes, nutrition and protein intake. Data collection was carried out through the clinical history of the different computerized databases of each hospital. Descriptive analysis and association between variables were performed using SPSS vs.20.0. RESULTS: A total of 574 patients were admitted for Covid-19, 43.03% were pronated. 69.6% were men, median age was 66 (IQR 55-74) and BMI 30.7 (RIC 27-34.2). Median ICU stay was 28 days (IQR 17-44.2), median hours on PD per patient 48 h (IQR 24-96). The incidence of PU occurrence was 56.3%, 76.2% of patients presented a PU, the most frequent location was the forehead (74.9%). There were significant differences between hospitals in terms of PU incidence (P = .002), location (P = .000) and median duration of hours per PD episode (P = .001). CONCLUSIONS: The incidence of pressure ulcers due to the prone position was very high. There is great variability in the incidence of pressure ulcers between hospitals, location and average duration of hours per episode of prone position.

Asunto(s)

COVID-19 , Úlcera por Presión , Anciano , Femenino , Humanos , Masculino , COVID-19/epidemiología , COVID-19/complicaciones , Incidencia , Unidades de Cuidados Intensivos , Úlcera por Presión/epidemiología , Úlcera por Presión/etiología , Úlcera por Presión/prevención & control , Posición Prona , Persona de Mediana Edad

Asunto(s)

Epilepsia , Trepanación , Humanos , Perú , Cráneo/cirugía , Epilepsia/cirugía

RESUMEN

INTRODUCCIÓN: Para la extracción de muestras de laboratorio a través de catéteres, se debe desechar un volumen de sangre para garantizar la exactitud de los resultados. OBJETIVOS: Analizar el volumen sanguíneo desechado obtenido a través de catéter vascular y relacionarlo con el tipo de catéter, la experiencia del profesional que realiza la extracción y el centro hospitalario, en las Unidades de Cuidados Intensivos (UCI) de adultos de les Illes Balears. MÉTODO: Estudio descriptivo multicéntrico transversal. Ámbito de estudio: Unidades de Cuidados Intensivos de adultos de les Illes Balears. Población: 296 enfermeras. Instrumento de recogida de datos: cuestionario ad hoc, anónimo y voluntario. Variables estudiadas: volumen de desecho, tipo de catéter, sexo, experiencia profesional y hospital. Análisis estadístico descriptivo, desviación estándar, coeficiente de variación y pruebas no paramétricas: Kruskal-Wallis y prueba de la mediana con un IC del 95%, mediante el programa SPSS vs20.0. RESULTADOS: Se obtuvieron 142 encuestas, participaron 12 hospitales: 6 públicos y 6 privados; el 72,5% mujeres y el 27,5% hombres. El volumen medio total desechado fue de 5,98± 3,01 ml: catéter venoso periférico (CVP) 5,74ml ± 2,85 ml, cánula arterial 4,37 ± 2,93ml, catéter central acceso periférico (PICC) 7,34±3,03 ml y catéter venoso central (CVC) 6,49± 2,99ml. Las medianas de volumen de desecho fueron muy variables entre las diferentes ucis (p <0,001). Los hospitales privados desechan mayores volúmenes que los públicos a través de CVP: 5,12± 2,15ml vs. 6,99± 2,80ml (p = 0,023), CVC: 5,92± 2,58 ml vs. 7,93± 1,71ml (p = 0,026) y PICC: 6,77± 2,73ml vs. 9,07± 2,05ml (p = 0,004). CONCLUSIONES: Existe una gran variabilidad en el volumen de sangre desechado en función del hospital donde se realiza la extracción. No se ha encontrado asociación entre la sangre desechada y el resto de variables estudiadas. Se deberían utilizar técnicas de extracción más conservadoras

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For laboratory sample extraction through catheters, blood volume must be discarded prior to specimen collection to ensure the accuracy of the results. OBJECTIVES: To analyse the discarded blood volume obtained through vascular catheters, according to type of catheter, professional experience in extraction and hospital in Adult Intensive Care Units (ICU) of the Balearic Islands. METHOD: Cross-sectional multicentre descriptive study. Conducted from April to December 2018. Field of study: Adult Intensive Care Units of the Balearic Islands. Population: 296 nurses. Sample: nursing professionals who answered the survey. Data collection instrument: ad hoc, anonymous and voluntary questionnaire. Variables studied: waste volume, type of catheter, sex, professional experience and hospital. Descriptive statistical analysis, standard deviation, coefficient of variation, and non-parametric tests: Kruskal-Wallis and Median test with an CI: 95%, using the SPSS vs20.0 programme. RESULTS: 142 surveys were obtained, 12 hospitals participated: 6 public and 6 private, 72.5% women and 27.5% men. The total mean volume discarded was 5.98ml (± 3.01): peripheral venous catheter (CVP) 5.74ml (± 2.85), arterial cannula 4.37ml (± 2.93), peripheral access central catheter (PICC) 7.34ml (± 3.03) and central venous catheter (CVC) 6.49ml (± 2.99). The medians of waste volume vary greatly between the different ICUs (p <.001). Private hospitals discard larger volumes than public hospitals through CVP: 5.12ml (±2.15) vs. 6.99ml (±2.80) (p=.023), CVC: 5.92ml (±2.58) vs. 7.93ml (±1.71) (p=.026) and PICC: 6.77ml (±2.73) vs. 9.07ml (±2.05) (p=.004). CONCLUSIONS: There is a great variability in the volume of blood discarded, it depends on the hospital. No association was found between the discarded blood and the other variables studied. More conservative extraction techniques should be used

Asunto(s)

Humanos , Masculino , Femenino , Volumen Sanguíneo , Unidades de Cuidados Intensivos , Recolección de Muestras de Sangre/instrumentación , Hemoglobinas/análisis , Competencia Clínica , Encuestas y Cuestionarios , Estudios Transversales , Intervalos de Confianza

RESUMEN

For laboratory sample extraction through catheters, blood volume must be discarded prior to specimen collection to ensure the accuracy of the results. OBJECTIVES: To analyse the discarded blood volume obtained through vascular catheters, according to type of catheter, professional experience in extraction and hospital in Adult Intensive Care Units (ICU) of the Balearic Islands. METHOD: Cross-sectional multicentre descriptive study. Conducted from April to December 2018. Field of study: Adult Intensive Care Units of the Balearic Islands. POPULATION: 296 nurses. SAMPLE: nursing professionals who answered the survey. Data collection instrument: ad hoc, anonymous and voluntary questionnaire. Variables studied: waste volume, type of catheter, sex, professional experience and hospital. Descriptive statistical analysis, standard deviation, coefficient of variation, and non-parametric tests: Kruskal-Wallis and Median test with an CI: 95%, using the SPSS vs20.0 programme. RESULTS: 142 surveys were obtained, 12 hospitals participated: 6 public and 6 private, 72.5% women and 27.5% men. The total mean volume discarded was 5.98ml (± 3.01): peripheral venous catheter (CVP) 5.74ml (± 2.85), arterial cannula 4.37ml (± 2.93), peripheral access central catheter (PICC) 7.34ml (± 3.03) and central venous catheter (CVC) 6.49ml (± 2.99). The medians of waste volume vary greatly between the different ICUs (p <.001). Private hospitals discard larger volumes than public hospitals through CVP: 5.12ml (±2.15) vs. 6.99ml (±2.80) (p=.023), CVC: 5.92ml (±2.58) vs. 7.93ml (±1.71) (p=.026) and PICC: 6.77ml (±2.73) vs. 9.07ml (±2.05) (p=.004). CONCLUSIONS: There is a great variability in the volume of blood discarded, it depends on the hospital. No association was found between the discarded blood and the other variables studied. More conservative extraction techniques should be used.

Asunto(s)

Recolección de Muestras de Sangre/métodos , Volumen Sanguíneo , Unidades de Cuidados Intensivos , Estudios Transversales , Femenino , Humanos , Masculino

RESUMEN

Objetivo: Calcular el número de analíticas y volumen de sangre extraído durante las primeras 24h de ingreso en la unidad de cuidados intensivos (UCI). Analizar valores de hemoglobina basal y a las 24h, relacionarlas con volumen de sangre extraído, balance ponderal e índices de gravedad. Método Estudio descriptivo, observacional y prospectivo. Variables de estudio: edad, sexo, diagnóstico de ingreso, analítica extraída, cantidad de desecho antes de la extracción de muestras, volumen de sangre total extraída en 24h, balance ponderal, índices de gravedad, hemoglobina basal y a las 24h. Análisis estadístico realizado mediante SPSS vs.20.0. Se han calculado las correlaciones de las variables sexo, balance, número de analíticas y variación de hemoglobina. Resultados La muestra estuvo formada por 100 pacientes. El número de extracciones medio por paciente/día fue de 7,2 (±2,6). La cantidad media de desecho fue de 32,61ml (±15,8). El volumen medio de sangre utilizado para determinaciones fue de 48,18ml (±16,74). El valor de la hemoglobina disminuyó las primeras 24h de ingreso, siendo mayor en los hombres (p<0,05). No se pudo demostrar que el número de analíticas estuviera relacionado con la diferencia de hemoglobina a las 24h. Los índices de gravedad tuvieron significación estadística en cuanto a los niveles de hemoglobina (Hb1: -0,3; p=0,001; Hb2: -0,4; p=0,001). Conclusiones: Del volumen total de sangre extraída en UCI, el 40% pertenece a volumen de desecho y el 60% a sangre utilizada para analíticas. Existe una disminución de la hemoglobina a las 24h de ingreso del paciente crítico, pero no se ha podido demostrar estadísticamente su relación con el número de analíticas (AU)

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Objective: To calculate the number of analytical tests and blood volume drawn during the first 24hours of admission to the Intensive Care Unit (ICU). To analyse values of basal haemoglobin and at 24hours, relate them to blood loss, weight variation, and scoring system. Method: An observational descriptive pilot study. Variables studied: age, sex, diagnosis on admission, analytical tests extracted, waste quantity before the extraction of samples, total volume blood extracted in 24hours, weight variation, APACHE, SAPS, basal haemoglobin and at 24hours. Statistical analysis with SPSS vs 20.0. Variables correlation sex, weight variation, the number of analytical tests and haemoglobin change. Results: The study included 100 patients. The average number of extractions per patient/day was 7.2 (±2.6). The average waste quantity was 32.61ml (±15.8). The blood volume used for determinations was 48.18ml / 24h (±16.74). The haemoglobin value decreased in the first 24hours of admission, being higher in men (P<.05). The scoring systems were statistically significant for levels of haemoglobin (Hb1 -0.3; P=.001; Hb2 -0.4; P=.001). Conclusions: Of the total volume of blood extracted in ICU, 40% belongs to a volume of waste and 60% of blood is used for analytical tests. There is a decrease in haemoglobin exists 24hours after admission of the critical patient. Statistically, it has not been possible to demonstrate its relation with the number of analytical tests (AU)

Asunto(s)

Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Volumen Sanguíneo , Enfermedad Crítica/enfermería , Anemia/sangre , Anemia/enfermería , Recolección de Muestras de Sangre/enfermería , Cuidados Críticos , Estudios Prospectivos

RESUMEN

OBJECTIVE: To calculate the number of analytical tests and blood volume drawn during the first 24hours of admission to the Intensive Care Unit (ICU). To analyse values of basal haemoglobin and at 24hours, relate them to blood loss, weight variation, and scoring system. METHOD: An observational descriptive pilot study. Variables studied: age, sex, diagnosis on admission, analytical tests extracted, waste quantity before the extraction of samples, total volume blood extracted in 24hours, weight variation, APACHE, SAPS, basal haemoglobin and at 24hours. Statistical analysis with SPSS vs 20.0. Variables correlation sex, weight variation, the number of analytical tests and haemoglobin change. RESULTS: The study included 100 patients. The average number of extractions per patient/day was 7.2 (±2.6). The average waste quantity was 32.61ml (±15.8). The blood volume used for determinations was 48.18ml / 24h (±16.74). The haemoglobin value decreased in the first 24hours of admission, being higher in men (P<.05). The scoring systems were statistically significant for levels of haemoglobin (Hb1 -0.3; P=.001; Hb2 -0.4; P=.001). CONCLUSIONS: Of the total volume of blood extracted in ICU, 40% belongs to a volume of waste and 60% of blood is used for analytical tests. There is a decrease in haemoglobin exists 24hours after admission of the critical patient. Statistically, it has not been possible to demonstrate its relation with the number of analytical tests.

Asunto(s)

Recolección de Muestras de Sangre/estadística & datos numéricos , Enfermedad Crítica , Femenino , Hemoglobinas/análisis , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Admisión del Paciente , Estudios Prospectivos , Factores de Tiempo

RESUMEN

Objetivo. Analizar el nivel de riesgo en la preparación y administración de los antibióticos de uso frecuente en la Unidad de Cuidados Intensivos utilizando una matriz de riesgo. Material y método. Se realizó un análisis de situación y una revisión bibliográfica en bases de datos, protocolos y guías de buenas prácticas sobre terapia intravenosa, medicamentos y vías de administración. Se llevó a cabo una selección de los antibióticos más utilizados en nuestra unidad registrados en el programa ENVIN-HELICS desde el 1 de abril al 30 de junio del 2015. Los pacientes que recibieron tratamiento antimicrobiano en este periodo fueron 257. Se evaluaron 26 antibióticos. Variables a estudio: evaluación del riesgo de cada antibiótico mediante la escala Risk Assessment Tools, de la National Patient Safety Agency, incluyendo pH, osmolaridad, tipo de catéter recomendado para su administración y compatibilidad e incompatibilidad con el resto de los antibióticos estudiados. Resultados. El 65,3% de los antibióticos tuvieron más de 3 factores de riesgo representados con una franja amarilla, y el 34,7% entre 0 y 2 factores de riesgo (franja verde.) No hubo ningún antibiótico con 6 o más factores de riesgo (franja roja). La mayoría de los fármacos necesitaron reconstitución, dilución adicional y la utilización de parte del vial para administrar la dosis prescrita. Conclusión. Más de la mitad de los antibióticos estudiados son de riesgo moderado, por lo que se deberían adoptar medidas para disminuirlo. La matriz de riesgo es una herramienta útil para la evaluación y detección de los puntos débiles asociados a la preparación y administración de antibióticos intravenosos (AU)

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Objective. To determine the level of risk in the preparation and administration of antibiotics frequently used in the Intensive Care Unit using a risk matrix. Material and method. A study was conducted using situation analysis and literature review of databases, protocols and good practice guidelines on intravenous therapy, drugs, and their administration routes. The most used antibiotics in the ICU registered in the ENVIN-HELICS program from 1 April to 30 June 2015 were selected. In this period, 257 patients received antimicrobial treatment and 26 antibiotics were evaluated. Variables studied: A risk assessment of each antibiotic using the scale Risk Assessment Tool, of the National Patient Safety Agency, as well as pH, osmolarity, type of catheter recommended for administration, and compatibility and incompatibility with other antibiotics studied. Results. Almost two-thirds (65.3%) of antibiotics had more than 3 risk factors (represented by a yellow stripe), with the remaining 34.7% of antibiotics having between 0 and 2 risk factors (represented by a green stripe). There were no antibiotics with 6 or more risk factors (represented by a red stripe). Most drugs needed reconstitution, additional dilution, and the use of part of the vial to administer the prescribed dose. Conclusion. More than half of the antibiotics studied had a moderate risk level; thus measures should be adopted in order to reduce it. The risk matrix is a useful tool for the assessment and detection of weaknesses associated with the preparation and administration of intravenous antibiotics (AU)

Asunto(s)

Humanos , Antibacterianos/administración & dosificación , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/prevención & control , Cuidados Críticos/métodos , Enfermedades Transmisibles/tratamiento farmacológico , Seguridad del Paciente/estadística & datos numéricos , Ajuste de Riesgo/métodos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Composición de Medicamentos/normas , Incompatibilidad de Medicamentos

RESUMEN

OBJECTIVE: To determine the level of risk in the preparation and administration of antibiotics frequently used in the Intensive Care Unit using a risk matrix. MATERIAL AND METHOD: A study was conducted using situation analysis and literature review of databases, protocols and good practice guidelines on intravenous therapy, drugs, and their administration routes. The most used antibiotics in the ICU registered in the ENVIN-HELICS program from 1 April to 30 June 2015 were selected. In this period, 257 patients received antimicrobial treatment and 26 antibiotics were evaluated. Variables studied: A risk assessment of each antibiotic using the scale Risk Assessment Tool, of the National Patient Safety Agency, as well as pH, osmolarity, type of catheter recommended for administration, and compatibility and incompatibility with other antibiotics studied. RESULTS: Almost two-thirds (65.3%) of antibiotics had more than 3 risk factors (represented by a yellow stripe), with the remaining 34.7% of antibiotics having between 0 and 2 risk factors (represented by a green stripe). There were no antibiotics with 6 or more risk factors (represented by a red stripe). Most drugs needed reconstitution, additional dilution, and the use of part of the vial to administer the prescribed dose. CONCLUSION: More than half of the antibiotics studied had a moderate risk level; thus measures should be adopted in order to reduce it. The risk matrix is a useful tool for the assessment and detection of weaknesses associated with the preparation and administration of intravenous antibiotics.

Asunto(s)

Antibacterianos/uso terapéutico , Seguridad del Paciente , Humanos , Unidades de Cuidados Intensivos , Errores de Medicación/prevención & control , Medición de Riesgo

RESUMEN

BACKGROUND: Several mechanisms are involved in the development of resistance to therapy in locally advanced cervical squamous cell carcinoma (LACSCC). Studies have shown that CD44 and Lewis Y antigen (LeY) form a complex that is associated with chemoresistance, tumor invasion and metastasis. We assessed the role of CD44 and LeY in the outcome of LACSCC patients treated with different chemotherapy regimens. METHODS: 126 LACSCC patients at FIGO stages IIB-IVA were selected from the GOCS database: 74 patients included in 3 different prospective phase II trials in the neoadjuvant setting (vinorelbine, docetaxel, ifosfamide-vinorelbine-cisplatin) and 52 patients treated with standard radiochemotherapy based on cisplatin (RCBC). Clinical data at baseline, disease-free survival (DFS) and overall survival (OS) were recorded. Univariate and multivariate Cox models were employed. RESULTS: Median age was 45.6 years (range: 24.9-80.5). Sixty-three and 47 tumors were CD44+ and LeY+, respectively. Tumors with expansive growth showed higher grade (p = 0.0024), mitotic index (p = 0.0505), tumor necrosis (p = 0.0191), LeY+ (p = 0.0034) and CD44+/LeY+ coexpression (p = 0.0334). CD44+ cells were present in 91.3% of patients with local recurrence (p = 0.0317). Advanced stage was associated with LeY+ tumors. Patients treated with RCBC had worse DFS and OS when their tumors expressed LeY (p = 0.0083 and p = 0.0137, respectively). Pre-treatment hemoglobin level, FIGO stage and tumor response remained the most significant prognostic factors in Cox regression. CONCLUSIONS: In our cohort of LACSCC patients, the coexpression of CD44 and LeY was not associated with worse outcome. However, in the subgroup of patients receiving RCBC, LeY expression was correlated with shorter DFS and OS.

Asunto(s)

Antineoplásicos/uso terapéutico , Carcinoma de Células Escamosas/tratamiento farmacológico , Carcinoma de Células Escamosas/inmunología , Cisplatino/uso terapéutico , Antígenos del Grupo Sanguíneo de Lewis/inmunología , Neoplasias del Cuello Uterino/tratamiento farmacológico , Neoplasias del Cuello Uterino/inmunología , Adulto , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/patología , Femenino , Humanos , Antígenos del Grupo Sanguíneo de Lewis/genética , Estadificación de Neoplasias , Neoplasias del Cuello Uterino/genética , Neoplasias del Cuello Uterino/patología

RESUMEN

BACKGROUND: Several studies in solid tumors have shown that expression of excision repair cross-complementation group 1 (ERCC1) and class III ß-tubulin (TUBB3) can predict response to chemoradiotherapy and might be prognostic factors. We assessed the role of ERCC1 and TUBB3 expressions as predictive and prognostic factors in locally advanced cervical squamous cell carcinoma (LACSCC) patients treated with different neoadjuvant regimens. METHODS: ERCC1 and TUBB3 were detected in 88 patients with LACSCC by immunohistochemical analysis. Sixty-two patients were included in 3 different prospective trials and grouped as follows: vinorelbine or docetaxel (group A, n = 44) and ifosfamide-vinorelbine-cisplatin (group B, n = 18). Both groups were compared with standard cisplatin chemoradiotherapy (group C, n = 26). Clinical data at baseline, disease-free survival (DFS) and overall survival (OS) were also collected. Univariate and multivariate Cox models were used to analyze the risk factors. RESULTS: Thirty-five patients (39.8%) and 18 (20.5%) had high ERCC1 and TUBB3 expression, respectively. Both proteins were overexpressed in tumors with unfavorable characteristics. High ERCC1 was associated with advanced FIGO stage (p = 0.034) and progressive disease (49% vs. 28%). Poor DFS (p = 0.021) and OS (p = 0.005) were observed in group C patients with high ERCC1 expression. Multivariate analysis showed that ERCC1 expression, FIGO stage and pretreatment hemoglobin level were significant prognostic factors (p = 0.002, p = 0.008 and p = 0.005, respectively). CONCLUSIONS: ERCC1 expression could be a predictive and prognostic factor in LACSCC patients who receive cisplatin monotherapy. Conversely, TUBB3 had no impact on survival in patients treated with antimicrotubule agents.

Asunto(s)

Carcinoma de Células Escamosas/metabolismo , Proteínas de Unión al ADN/análisis , Endonucleasas/análisis , Proteínas de Neoplasias/análisis , Tubulina (Proteína)/análisis , Neoplasias del Cuello Uterino/metabolismo , Adulto , Anciano , Antineoplásicos Alquilantes/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Braquiterapia , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/terapia , Quimioradioterapia , Cisplatino/administración & dosificación , Cisplatino/uso terapéutico , Ensayos Clínicos Fase II como Asunto , Proteínas de Unión al ADN/biosíntesis , Progresión de la Enfermedad , Supervivencia sin Enfermedad , Endonucleasas/biosíntesis , Femenino , Regulación Neoplásica de la Expresión Génica , Humanos , Histerectomía , Ifosfamida/administración & dosificación , Estimación de Kaplan-Meier , Mesna/administración & dosificación , Persona de Mediana Edad , Proteínas de Neoplasias/biosíntesis , Cuidados Paliativos , Pronóstico , Radioterapia Adyuvante , Tubulina (Proteína)/biosíntesis , Neoplasias del Cuello Uterino/mortalidad , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/terapia , Vinblastina/administración & dosificación , Vinblastina/análogos & derivados , Vinorelbina

RESUMEN

INTRODUCCIÓN: La nutrición parenteral periférica (NPP) es una nutrición artificial utilizada cuando la absorción por vía digestiva es insuficiente. Suple las demandas nutricionales del paciente. Permite su administración por vía periférica. A continuación se presentan 2 casos clínicos. El primero es una epidermólisis por extravasación enmascarada por desorientación temporoespacial del paciente, con aparición de flictenas. Requirió tratamiento prolongado y consulta a cirugía plástica. El segundo caso es una flebitis química con detección precoz por parte de los profesionales de enfermería. Se resolvió con tratamiento a corto plazo y no precisó interconsulta. Plan de cuidados Se elaboró un plan de cuidados dirigido a identificar los problemas potenciales o reales relacionados con las posibles complicaciones de la administración intravenosa de la NPP, como son la extravasación y la flebitis, actuando en la prevención, detección precoz y tratamiento. Discusión: La flebitis está relacionada con las características del catéter, con el tiempo de permanencia y con la alta osmolaridad de la NPP. Una actuación precoz disminuye la lesión del tejido afectado. En el caso 1 el paciente requiere curas durante 19 días, mientras que en el caso 2 solo las precisa 72 h. Conclusión La enfermera desempeña un papel primordial en la elección del catéter, localización, administración y prevención de complicaciones. El adiestramiento del personal y la protocolización del procedimiento minimizan la incidencia de flebitis, evita molestias a los pacientes y reduce el gasto sanitario

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INTRODUCTION: Peripheral parenteral nutrition (PPN) is artificial nutrition used when digestive absorption is insufficient. It supplies the nutritional needs of the patient and permits administration through a peripheral catheter. We present 2 clinical cases.: The first one entails an epidermolisis through extravasation masked by temporo-spatial disorientation of the patient with appearance of fiictenes (blisters).Prolonged treatment and consultation with plastic surgery were required. The second case entails a chemical phlebitis with early detection by nursing professionals. It was resolved with short term treatment and did not require consultation with the plasticsurgeon. Planning care: We elaborated a care plan aimed at identifying real or potential problems related with possible complications of intravenous PPN administration, such as phlebitis and extravasation. The aim of this research was prevention, early detection and treatment. Discussion: Phlebitis is related with catheter characteristics, in-dwelling time and high osmolarity of PPN. Early action decreases injury of the affected tissue. In case 1, the patient requires 19 days of curing. This was only 72 h in case 2. CONCLUSION: The nursing staff plays an essential role in catheter election, localization, administration and preventing complications. Staff training and a procedure protocol greatly reducethe incidence of phlebitis, avoid discomfort for the patient and reduce health care cost

Asunto(s)

Humanos , Nutrición Parenteral/efectos adversos , Extravasación de Materiales Terapéuticos y Diagnósticos/complicaciones , Diagnóstico de Enfermería/métodos , Atención de Enfermería/métodos

RESUMEN

INTRODUCTION: Peripheral parenteral nutrition (PPN) is artificial nutrition used when digestive absorption is insufficient. It supplies the nutritional needs of the patient and permits administration through a peripheral catheter. WE PRESENT 2 CLINICAL CASES: The first one entails an epidermolisis through extravasation masked by temporo-spatial disorientation of the patient with appearance of flictenes (blisters). Prolonged treatment and consultation with plastic surgery were required. The second case entails a chemical phlebitis with early detection by nursing professionals. It was resolved with short term treatment and did not require consultation with the plastic surgeon. PLANNING CARE: We elaborated a care plan aimed at identifying real or potential problems related with possible complications of intravenous PPN administration, such as phlebitis and extravasation. The aim of this research was prevention, early detection and treatment. DISCUSSION: Phlebitis is related with catheter characteristics, in-dwelling time and high osmolarity of PPN. Early action decreases injury of the affected tissue. In case 1, the patient requires 19 days of curing. This was only 72 h in case 2. CONCLUSION: The nursing staff plays an essential role in catheter election, localization, administration and preventing complications. Staff training and a procedure protocol greatly reduce the incidence of phlebitis, avoid discomfort for the patient and reduce health care cost.

Asunto(s)

Nutrición Parenteral/efectos adversos , Flebitis/etiología , Enfermedades de la Piel/etiología , Adulto , Anciano , Humanos , Masculino

RESUMEN

Abstract Background: in Colombia, the law (Resolution 1382, 2013) prohibits the sale of milk that contains any antimicrobial drug residues, although no specific official screening tests and detection limits have been specified. At present, milk with positive results to both the Delvotest® and Snap® assays is simply rejected. To avoid contaminating bulk tanks with milk from individually treated cows, producers would benefit from having on-farm screening tests to conduct their own quality controls. In addition, on-site testing would allow farmers to check if the withdrawal times of commercially-available generic products are in accordance with labeled recommendations. Material and Methods: In this study, two commonly used rapid detection tests (Delvotest® and SNAP® specific for beta-lactams) were used on milk from 39 subclinical mastitic Holstein cows that were prescribed with daily intramuscular injections of a commercial suspension containing 8.000.000 IU of penicilin G (75% procaine penicilin G, 25% potasium penicillin) and 8 g of streptomycin sulfate, for a total of 4 days. Cows were individually milked and samples collected every 12 hours the day before, and for 3 days after the recommended withdrawal time of three days post-treatment. To inactivate the potential action of natural inhibitors of microbial growth that may be present in milk (ie., lysozyme and lactoferrin), the results of the Delvotest® were compared before and after milk samples were subjected to heat treatment (82°C for 5 minutes). Results: When the Delvotest® was used as per manufacturer's instructions (i.e., without heating), 7 of 39 cows were positive for one more day past the recommended withdrawal period. However, the results of the Snap® specific for beta-lactams and Delvotest® post-heating showed that only 2 of those 7 cows were positive, suggesting that 5 animals gave false positive results. For the 312 milk samples analyzed, a high degree of concordance was observed (Kappa coefficient=0.74±0.1) between the Snap® and Delvotest® post-heating. Conclusions: Considering that the streptomycin in this product is known to be eliminated faster than penicillin-G, the results suggest that the efficacy of the Delvotest® (after heat treatment) is similar to that of the Snap® beta-lactams for the detection of penicillin residues. However, when the Delvotest® was not preceded by heat treatment to inactivate potential natural inhibitors, it yielded a high number of false-positive results. The results also showed that in 95% (37/39) of the cows treated with this commercial product, the labeled instructions of a 3 day withdrawal period were adequate for compliance within the law.

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Resumen En Colombia, la ley (Resolución 1382, 2013) prohíbe la venta de leche que contenga residuos de cualquier medicamento antimicrobiano, aunque no se especifican pruebas oficiales ni límites de detección que deban cumplir. Actualmente, la leche que emite resultados positivos a los kits del Delvotest® y Snap® simplemente es rechazada. Para evitar contaminar tanques de acopio con leche de vacas tratadas, los productores se beneficiarían de tener pruebas in situ que les permitan hacer sus propios controles. Además, ello permitiría comprobar si los tiempos de descarte de productos comerciales cumplen con las recomendaciones de los insertos. En este estudio se evaluaron dos pruebas de detección rápida (Delvotest® y SNAP® específico parar beta-lactámicos) en leche de 39 vacas con mastitis subclínica que fueron tratadas con inyecciones diarias intramusculares de una suspensión comercial de 8.000.000 UI de penicilina G (75% penicilina procaínica G, 25% penicilina potásica) y 8 g de sulfato de estreptomicina, durante 4 días. Las vacas se ordeñaron manualmente y recolectaron muestras de leche, cada 12 horas, por 1 día antes y 3 después del tiempo de retiro recomendable de 3 días post-tratamiento. Para inactivar la acción de inhibidores naturales del crecimiento bacteriano que pueden estar presentes en leche (ej, lisozima y lactoferrina), los resultados del Delvotest® se compararon antes y después de que las muestras de leche fuesen sometidas a calentamiento (82°C por 5 minutos). Cuando el Delvotest® se usó de acuerdo a las instrucciones de la compañía, es decir, sin calentamiento, 7 de 39 vacas dieron positivas por ≥ 1 días pasado el tiempo de retiro recomendado. Sin embargo, los resultados del Snap® y Delvotest® post-calentamiento mostraron que sólo 2 de las 7 vacas eran positivas, sugiriendo que 5 animales estaban dando falsos positivos. En las 312 muestras de leche analizadas se obtuvo un alto grado de concordancia (coeficiente Kappa = 0.74±0.1) entre el Snap® y el Delvotest® post-calentamiento. En conclusión, los resultados sugieren que la eficacia del Delvotest® (post-calentamiento) es similar a la del Snap® específico para beta-lactámicos en lo que respecta a detección de residuos de penicilina. Sin embargo, cuando el Delvotest® no iba precedido de calentamiento para inactivar inhibidores naturales, se produjeron demasiados falsos positivos. Los resultados también mostraron que en el 95% (37/39) de las vacas tratadas con este producto, la recomendación de descarte por 3 días cumplía con la legislación vigente de no contener residuos.

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Resumo Na Colômbia, a lei (Resolução 1382 de 2013) proíbe a venda do leite que tenha resíduos de qualquer medicamento antimicrobiano, embora não se especifiquem testes oficiais nem limites de detecção que devam se cumprir. Atualmente, o leite que emite resultados positivos aos Kits de Delvotest® e Snap® simplesmente é rejeitado. Para evitar contaminar os tanques de armazenamento com leite de vacas tratadas, os produtores beneficiar-se-iam de ter os testes in situ que lhes permita fazer seus próprios controles. Além, isto permitiria comprovar se os tempos de retiro do leite ao utilizar produtos comerciais cumprem com as recomendações da vide bula. Neste estudo avaliaram-se dois testes de detecção rápida (Delvotest® e SNAP® especifico parar beta-lactâmicos) no leite de 39 vacas com mastite subclínica que foram tratadas com injeções diárias intramusculares de uma suspensão comercial de 8.000.000 UI de penicilina G (75% penicilina procaína G, 25% penicilina potássica) e 8g de sulfato de estreptomicina durante quatro dias. Extraiu-se o leite das vacas com ordenha manual e se fez uma amostragem de leite (cada 12 horas) um dia antes e três dias depois do tempo de retiro do leite, que tinha como recomendável, na vide bula, três dias após final do tratamento. Para inativar a ação de inibidores naturais do crescimento bacteriano, que possam estar presentes no leite (ex. lisozima e lactoferrina), os resultados do Delvotest® compararam-se antes e depois de que as amostras de leite fossem sometidas a aquecimento (82°C durante 5 minutos). Quando o Delvotest® usou-se de acordo com as instruções da companhia, quer dizer, sem aquecimento, sete das 39 vacas deram positivas por ≥ 1 dia passado o tempo de retiro recomendado. Embora, os resultados do Snap® e Delvotest® após aquecimento do leite mostraram que só dois das sete vacas eram positivas, sugerindo que cinco animais estavam apresentando falsos positivos. Nas 312 amostras de leite analisadas obteve-se um alto grau de concordância (coeficiente Kappa = 0.74±0.1) entre o Snap® e o Delvotest® após aquecer o leite. Em conclusão, os resultados sugerem que a eficácia do Delvotest® (após o aquecimento do leite) é similar á do Snap ou especifico para beta-lactâmicos no que respeita a detecção de resíduos de penicilina. Embora, quando o Delvotest® não ia precedido do aquecimento do leite para inativar inibidores naturais, produziram-se muitos falsos positivos. Os resultados também demonstraram que o 95% (37/39) das vacas tratadas com este produto, estavam de acordo com a recomendação de descarte por três dias e cumpria com a legislação vigente de não conter resíduos.

RESUMEN

Introducción En una unidad de cuidados intensivos (UCI), se llevó a cabo una investigación-acción participativa (IAP), cuyo objetivo general era promover el cambio de práctica clínica para mejorar los cuidados ofertados a los familiares del paciente crítico. Como resultado de este proceso se implantaron cuatro iniciativas de cambio. Además, uno de los objetivos específicos era explorar cómo el contexto de esta unidad limitaba y facilitaba el cambio. Este artículo presenta los hallazgos derivados de este objetivo. Material y métodos Metodología cualitativa. Diseño IAP. Técnicas de recogida de datos11 grupos de discusión con profesionales, 5 entrevistas en profundidad a profesionales, diarios de campo de los participantes y diario de campo de la investigadora principal. Participaron 11 profesionales en los grupos de discusión (cada uno trasmitía las aportaciones de 3-5 compañeros), 5 profesionales en las entrevistas, 11 profesionales llevaron a cabo diario de campo. Se realizó análisis de contenido. Resultados Los aspectos que limitan el cambio son: 1) no reconocer la legitimidad de la evidencia científica acerca de los familiares del paciente crítico; 2) relaciones de poder desequilibradas en el equipo multidisciplinar; 3) falta de participación de las enfermeras en los flujos de información; 4) organización del tiempo y del espacio de la unidad. Los que lo facilitan: 1) el compromiso individual y el compromiso compartido; 2) el liderazgo en lo cotidiano; 3) el proceso reflexivo. Conclusiones Un proceso de IAP puede conducir el cambio en la práctica clínica, aunque este es complejo y requiere de una alta inversión de energía personal. Los factores contextuales que lo limitan están integrados en la estructura de la unidad, mientras que los facilitadores son coyunturales y dependen de personas individuales. En este sentido, los profesionales a pie de cama tienen capacidad para introducir cambios en su contexto (AU)

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Introduction: Participatory action research (PAR) was conducted in an intensive care unit (UCI),with the general purpose of fostering change in clinical practice so as to improve the care offered to families of critically ill patients. As a result of this process, four change-related initiatives were introduced. One specific additional objective was to explore how the unit’s background context limited or facilitated change. This paper presents findings based on this objective. Materials and methods: Qualitative methodology. Design: Participatory-action research (PAR).Data gathering techniques: 11 discussion groups incorporating professionals, 5 in-depth interviews with professionals, field diaries kept by the participants, and field diary kept by the lead researcher. Eleven professionals took part in the discussion groups (each one conveyed information made known to them by 3-5 colleagues), 5 professionals were involved in the interviews, and 11 professionals filled in a field diary. A content analysis was performed. Results: Factors limiting change included: 1) Not acknowledging the legitimacy of scientific evidence regarding the families of critically ill patients; 2) Imbalanced power relationships among the members of multi-disciplinary teams; 3) Nurses’ lack of involvement in informationflow; 4) The organization of time and physical space in the unit. Factors facilitating change: 1)A sense of individual and shared (..) (AU)

Asunto(s)

Humanos , Mejoramiento de la Calidad , Unidades de Cuidados Intensivos/tendencias , Cambio Social , Apoyo Social , Investigación Cualitativa , Relaciones Profesional-Familia

Asunto(s)

Humanos , Accidente Cerebrovascular/complicaciones , Convulsiones , Epilepsia

RESUMEN

INTRODUCTION: Participatory action research (PAR) was conducted in an intensive care unit (UCI), with the general purpose of fostering change in clinical practice so as to improve the care offered to families of critically ill patients. As a result of this process, four change-related initiatives were introduced. One specific additional objective was to explore how the unit's background context limited or facilitated change. This paper presents findings based on this objective. MATERIALS AND METHODS: Qualitative methodology. DESIGN: Participatory-action research (PAR). DATA GATHERING TECHNIQUES: 11 discussion groups incorporating professionals, 5 in-depth interviews with professionals, field diaries kept by the participants, and field diary kept by the lead researcher. Eleven professionals took part in the discussion groups (each one conveyed information made known to them by 3-5 colleagues), 5 professionals were involved in the interviews, and 11 professionals filled in a field diary. A content analysis was performed. RESULTS: Factors limiting change included: 1) Not acknowledging the legitimacy of scientific evidence regarding the families of critically ill patients; 2) Imbalanced power relationships among the members of multi-disciplinary teams; 3) Nurses' lack of involvement in information flow; 4) The organization of time and physical space in the unit. Factors facilitating change: 1) A sense of individual and shared commitment; 2) Leadership in day-to-day matters; 3) A process based on reflection. CONCLUSIONS: A process of participatory action research can lead to change in clinical practice, although this is complex and requires substantial input in terms of personal energy. Contextual factors limiting this change are related to the actual structure of the unit, while factors facilitating it are circumstantial ones and are dependent upon individual people. In this sense, professionals working at the bedside are capable of introducing changes to the context in which they work.

Asunto(s)

Cuidados Críticos , Enfermedad Crítica , Familia , Humanos

RESUMEN

The injection of Botulinum toxin type A (BoNT/A) into the prostate is a minimally invasive alternative treatment for lower urinary tract symptoms. To summarize the action mechanisms of BoNT/A on experimental animals and to analyze its effectiveness according to published clinical studies, we located 24 papers on the treatment of HBP with BoNT/A. The doses applied ranged from 100 (OnabotA) to 600 U (OnabotA and AbobotA). The IPSS score presented a mean post-treatment reduction, for all series, of 10.8 + 2.66 points. Other significant results included the overall mean reduction in QoL score of 2.1 ± 0.62 points, and the pre and post-treatment differences in prostate volume (22.43 ± 20.2 cm(3)), post-voiding residue (76.77 + 51.72 cm(3)) and PSA (1.15 + 0.93 ng/ml). However, only two clinical trials were on sufficient quality to be selected for meta-analysis, and it was observed that the difference of the means, pre- and post-treatment of maximum flow, prostate volume, IPSS and PSA were not statistically significant (P = 0.18). Neither was there any statistically significant difference between pre- and post-treatment post-voiding residue (P = 0.65). In conclusion, BoNT/A alleviates lower urinary tract symptoms due to HBP, but different studies present considerable variations regarding the dose administered, inclusion criteria and follow-up time, as well as poorly defined retreatment, losses to follow up and, above all, a high degree of variability in the communication of results (with large standard deviations). In consequence, further clinical trials are needed.

Asunto(s)

Toxinas Botulínicas Tipo A/uso terapéutico , Síntomas del Sistema Urinario Inferior/tratamiento farmacológico , Hiperplasia Prostática/tratamiento farmacológico , Animales , Toxinas Botulínicas Tipo A/administración & dosificación , Relación Dosis-Respuesta a Droga , Humanos , Inyecciones , Síntomas del Sistema Urinario Inferior/etiología , Masculino , Modelos Animales , Hiperplasia Prostática/complicaciones , Resultado del Tratamiento