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Diaz-Gomez D.,Hospital Universitario Of Valme | Parra-Membrives P.,Hospital Universitario Of Valme | Villegas-Portero R.,Hospitales Universitarios Virgen Of Rocio | Molina-Linde M.,Agencia de Evaluacion de Tecnologias Sanitarias de Andalucia | And 2 more authors.
Cirugia Espanola | Year: 2012

Introduction: Acute cholecystitis (AC) is a common indication for cholecystectomy. Local circumstances and certain patient characteristics lead to high failure rates and complications in laparoscopic cholecystectomy (LC), and despite the experience gained, we still do not have a detailed list of indications which could minimise them. Material and method: We used the RAND/UCLA Appropriateness Method (RAM) to evaluate 2 options, LC and open cholecystectomy (OC). An expert panel analysed its suitability after a literature review, a consensus meeting, and 2 rounds of scores on different clinical situations. The score of each scenario was analysed to establish the appropriateness level of each option. Results: At the end of the meeting there were 64 defined scenarios, with an agreement being reached on the indications in 67.18% of them. In 86.04% of the scenarios, the agreement was due to the appropriateness of the indications. When cholecystectomy was indicated, it was always by laparoscopy, while it was only occasionally by laparotomy. In patients with less than 72. h of onset, LC was always considered appropriate when there was sepsis, or even without this if the ultrasound data showed complicated AC. Conclusions: There is still uncertainty as regards the management of AC, especially as regards the timing of the operation and the surgical approach, particularly in frail patients and with a clinical onset greater than 72. h. The RAND method can help to make decisions on the appropriateness of different therapeutic options. © 2012 AEC.

Llanos Mendez A.,Agencia de Evaluacion de Tecnologias Sanitarias de Andalucia | Diaz Molina C.,Hospital Universitario Reina Sofia | Fernandez-Crehuet Navajas R.,University of Cordoba, Spain
Cirugia Espanola | Year: 2010

Introduction: Surgical site infection (SSI) is a very common problem in hospital infection control. It represents a risk for the safety of the patient and therefore its reduction is a priority in Health Services. The aim of the study is to analyse the incidence of SSI in the surgical departments of a tertiary hospital. Material and methods: A prospective cohort study was conducted on 14,455 patients admitted from January 2001 to December 2004. The cumulative incidence (CI) crude and adjusted for the National Nosocomial Infection Surveillance (NNIS) index and the incidence density (ID) of SSI were calculated. Results: The CI of patients with SSI was 3.4% (95% CI: 3.0-3.7%), the CI of SSI was 3.5% and the observed ID was 0.28/100 surgical patients/day. Surgical units with the highest CI were maxillofacial (6%), gastrointestinal (5.3%) and cardiovascular (5.1%). Adjusting for length of stay, urology and paediatric surgery recorded the highest incidence rates, while ophthalmology and neurosurgery had the least. Colorectal surgery had the highest parameters (CI=10%; ID=0.57), followed by myocardial revascularisation and hip prosthesis. Among the surgical units and operative procedures assessed, the CI of SSI increased with the NNIS index. Conclusions: The CI and ID of SSI observed in this study were similar to those obtained in previous European surveillance projects, and lower than those recorded in our hospital in 1994 which reflects a higher level of vigilance and a higher awareness in applying control measures. © 2010 AEC.

Moreno-Ramirez D.,Hospital Universitario Virgen Macarena | De la Cruz-Merino L.,Hospital Universitario Virgen Macarena | Ferrandiz L.,Hospital Universitario Virgen Macarena | Villegas-Portero R.,Agencia de Evaluacion de Tecnologias Sanitarias de Andalucia | Nieto-Garcia A.,University of Seville
Oncologist | Year: 2010

Background. Isolated limb perfusion (ILP) involves the administration of chemotherapy drugs directly into a limb involved by locoregional metastases. Unresectable locally advanced melanoma of the limbs represents one of the clinical settings in which ILP has demonstrated benefits. Methods. A systematic review of the literature on ILP for patients with unresectable locally advanced melanoma of the limbs was conducted. MEDLINE, EMBASE, and Cochrane database searches were conducted to identify studies fulfilling the following inclusion criteria: hyper- or normothermic ILP with melphalan with or without tumor necrosis factor (TNF) or other drugs providing valid data on clinical response, survival, or toxicity. To allocate levels of evidence and grades of recommendation the Scottish Intercollegiate Guidelines Network system was used. Results. Twenty-two studies including 2,018 ILPs were selected with a clear predominance of observational studies (90.90%) against experimental studies (9.10%). The median complete response rate to ILP was of 58.20%, with a median overall response rate of 90.35%. ILP with melphalan yielded a median complete response rate of 46.50%, against a 68.90% median complete response rate for melphalan plus TNF ILP. The median 5-year overall-survival rate was 36.50%, with a median overall survival interval of 36.70 months. The Wieberdink IV and V regional toxicity rates were 2.00% and 0.65%, respectively. Conclusions. ILP is effective in achieving clinical responses in patients with unresectable locally advanced melanoma of the limbs. The disease-free and overall survival rates provided by ILP are acceptable. ILP is safe, with a low incidence of severe regional and systemic toxicity. © AlphaMed Press.

Alfaro-Lara E.R.,Hospital Universitario Virgen Del Rocio | Vega-Coca M.D.,Agencia de Evaluacion de Tecnologias Sanitarias de Andalucia | Galvan-Banqueri M.,Hospital Universitario Virgen Del Rocio | Nieto-Martin M.D.,Hospital Universitario Virgen Del Rocio | And 2 more authors.
Atencion Primaria | Year: 2014

Objective To carry out a bibliographic review in order to identify the different methodologies used along the reconciliation process of drug therapy applicable to polypathological patients. Design We performed a literature review. Data sources The bibliographic review (February 2012) included the following databases: Pubmed, EMBASE, CINAHL, PsycINFO and Spanish Medical Index (IME). The different methodologies, identified on those databases, to measure the conciliation process in polypathological patients, or otherwise elderly patients or polypharmacy, were studied. Study selection Two hundred and seventy three articles were retrieved, of which 25 were selected. Data extraction Specifically: the level of care, the sources of information, the use of registration forms, the established time, the medical professional in charge and the registered variables such as errors of reconciliation. Results Most of studies selected when the patient was admitted into the hospital and after the hospital discharge of the patient. The main sources of information to be highlighted are: the interview and the medical history of the patient. An established time is not explicitly stated on most of them, nor the registration form is used. The main professional in charge is the clinical pharmacologist. Apart from the home medication, the habits of self-medication and phytotherapy are also identified. The common errors of reconciliation vary from the omission of drugs to different forms of interaction with other medicinal products (drugs interactions). Conclusions There is a large heterogeneity of methodologies used for reconciliation. There is not any work done on the specific figure of the polypathological patient, which precisely requires a standardized methodology due to its complexity and its susceptibility to errors of reconciliation. © 2013 Elsevier España, S.L. Todos los derechos reservados.

Llanos Mendez A.,Agencia de Evaluacion de Tecnologias Sanitarias de Andalucia | Prieto Uceda M.,Hospital Puerto Real
Emergencias | Year: 2014

This systematic review to assess the efficacy and safety of therapeutic hypothermia to treat ischemic stroke was based on searches of the MEDLINE, Embase, and Web of Science databases and other sources. A total of 534 potentially relevant publications were found. Six studies (5 clinical trials and 1 quasi-experimental study) that reported results for mortality, neurologic function, or safety were reviewed. The Critical Appraisal Skills Programme tools (Spanish versions) and the Jadad scoring system were used to guide critical analysis. The selected articles proved to have low risk of bias but limitations on external validity. Meta-analysis revealed a tendency to higher mortality for patients undergoing induced hypothermia (relative risk, 1.67; 95% confidence interval, 0.95-2.91) and no significant differences for neurologic function between treatment groups. The experimental group had a higher percentage of adverse events. Our conclusion is that the evidence does not support the efficacy and safety of therapeutic induction of hypothermia to treat ischemic stroke.

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