Freixas N.,Hospital Universitari Mutua Of Terrassa |
Bella F.,Consorci Sanitari de Terrassa |
Limon E.,at Coordinator Center |
Pujol M.,at Coordinator Center |
And 4 more authors.
Clinical Microbiology and Infection | Year: 2013
To determine the impact of a multimodal intervention designed to reduce the incidence of catheter-related bloodstream infections (CRBSIs) outside the ICU, we conducted a prospective, quasi-experimental, before-after intervention study in 11 hospitals participating in the VINCat programme in Catalonia, Spain. The intervention consists of: (i) an evidence-based bundle of practices relating to catheter insertion and maintenance; (ii) a training programme for healthcare workers; (iii) four point-prevalence surveys to track the status of the catheters; and (iv) feedback reports to the staff involved. The study included both central (CVC) and peripheral venous catheters (PVCs). Rates of CRBSI per 1000 patient-days were prospectively measured in 2009 (pre-intervention period) and 2010 (post-intervention period). The analysis included 1191843 patient-days in 2009 and 1173672 patient-days in 2010. The overall incidence of CRBSI decreased from 0.19 to 0.15 (p0.04) and the incidence of CRBSI associated with a CVC decreased from 0.14 to 0.10 (p0.004) after the intervention. The incidence in PVCs remained unchanged. There was a statistically significant improvement in the adequate maintenance of both CVCs and PVCs. Among the CRBSIs originating in PVCs, 61.8% appeared more than 72h every insertion. There was a lower infection rate in the hospitals with a higher adherence to the recommendation to replace PVCs after 72h. Our findings suggest that the implementation of intervention programmes similar to ours could have a major impact on patient safety by reducing the incidence of CRBSIs, and that routine replacement of PVCs might additionally prevent a significant number of bloodstream infections. © 2012 European Society of Clinical Microbiology and Infectious Diseases.
Alba E.,Hospital Universitario Virgen Of La Victoria |
De la Haba J.R.,Hospital Reina Sofia |
Arcusa Lanza A.,Consorci Sanitari de Terrassa |
Chacon J.I.,H Virgen de la Salud |
And 5 more authors.
Annals of Oncology | Year: 2012
Background: Luminal breast cancer is a highly endocrine responsive disease. However, the therapeutic benefit of chemotherapy (CT) in this population is not fully characterized. This study investigates the value of CT and hormone therapy (HT) in luminal breast cancer patients in the neoadjuvant setting. Patients and Methods: Patients with operable breast cancer and immunophenotypically defined luminal disease (ER+/PR+/HER2-/cytokeratin 8/18+) were recruited. Patients were randomized to CT (epirubicin 90 mg/m. 2 plus cyclophosphamide 600 mg/m. 2 × 4 cycles followed by docetaxel 100 mg/m. 2× 4 cycles [EC-T]) or HT (exemestane 25 mg daily × 24 weeks [combined with goserelin in premenopausal patients]). The primary end point was the clinical response measured by magnetic resonance imaging. Results: Ninety-five patients were randomized (47 CT, 48 HT). The clinical response rate was 66% for CT and 48% for HT (P = 0.075). We performed an unplanned analysis based on Ki67 levels (cut-off of 10%). Similar clinical response was seen between arms in patients with low Ki67 (CT: 63%, HT: 58%; P = 0.74); patients with high Ki67 had a better response with CT (67 versus 42%; P = 0.075). Grade 3/4 toxicity was more frequent with CT. Conclusions: Luminal immunophenotype is not enough to identify patients who do not benefit from neoadjuvant CT. Luminal patients with low proliferation index could potentially avoid CT. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.
Panes J.,Hospital Clinic IDIBAPS |
Panes J.,Research Center Biomedica En Red En El Area Tematica Of Enfermedades Hepaticas gestivas |
Lopez-Sanroman A.,Hospital Ramon y Cajal |
Bermejo F.,Hospital Of Fuenlabrada |
And 14 more authors.
Gastroenterology | Year: 2013
Background & Aims A small placebo-controlled trial reported the efficacy of mercaptopurine therapy for children newly diagnosed with Crohn's disease, yet little is known about the efficacy of early thiopurine therapy in adults. Methods We performed a prospective double-blind trial of adult patients with a recent (<8 weeks) diagnosis of Crohn's disease. Patients were randomly assigned to groups given azathioprine (2.5 mg · kg-1 · day-1, n = 68) or placebo (n = 63) at 31 hospitals from February 2006 to September 2009. Corticosteroids but no other concomitant medications were allowed for control of disease activity. The primary measure of efficacy was sustained corticosteroid-free remission. Results After 76 weeks of treatment, 30 patients treated with azathioprine (44.1%) and 23 given placebo (36.5%) were in sustained corticosteroid-free remission (difference of 7.6%; 95% confidence interval, -9.2 to 24.4%; P =.48). The rates of relapse (defined as Crohn's Disease Activity Index score >175) and corticosteroid requirements were similar between groups. A post hoc analysis of relapse, defined as a Crohn's Disease Activity Index score >220, showed lower relapse rates in the azathioprine group than in the placebo group (11.8% vs 30.2%; P =.01). Serious adverse events occurred in 14 patients in the azathioprine group (20.6%) and 7 in the placebo group (11.1%) (P =.16). A larger percentage of patients in the azathioprine group had adverse events that led to study drug discontinuation (20.6%) than in the placebo group (6.35%) (P =.02). Conclusions In a study of adults with Crohn's disease, early azathioprine therapy was no more effective than placebo to achieve sustained corticosteroid-free remission but was more effective in preventing moderate to severe relapse in a post hoc analysis. EudraCT 2005-001186-34. © 2013 by the AGA Institute.
Hotouras A.,Royal London Hospital |
Hotouras A.,Whittington Hospital NHS Trust |
Ribas Y.,Consorci Sanitari de Terrassa |
Zakeri S.,Whittington Hospital NHS Trust |
And 4 more authors.
Colorectal Disease | Year: 2015
Aim: There are no available guidelines to support surgical decision-making in recurrent rectal prolapse. This systematic review evaluated the results of abdominal or perineal surgery for recurrent rectal prolapse, with the aim of developing an evidence-based treatment algorithm. Method: PubMed and MEDLINE databases were searched for all clinical studies involving patients who underwent surgery for recurrent rectal prolapse between 1950 and 2014. The primary outcome measure was the recurrence rate after abdominal or perineal surgery for recurrent rectal prolapse. Secondary outcomes included morbidity, mortality and quality of life data where available. Results: There were no randomized controlled studies comparing the success rates of abdominal or perineal surgery for recurrent rectal prolapse. Most studies were heterogeneous, of low quality (level IV) and involved small numbers of patients. The follow-up of 144 patients included in the studies undergoing perineal surgery ranged from 8.8 to 81 months, with recurrence rates varying from 0% to 50%. Morbidity ranged from 0% to 17% with no mortality reported. Limited data on quality of life following the Altemeier procedure were available. The follow-up for 158 patients included in the studies who underwent abdominal surgery ranged from 0 to 23 years, during which recurrence rates varied from 0% to 15%. Morbidity rates ranged from 0% to 32% with 4% mortality. No quality of life data were available for patients undergoing abdominal surgery. Conclusion: This systematic review was unable to develop a treatment algorithm for recurrent rectal prolapse due to the variety of surgical techniques described and the low level of evidence within heterogeneous studies. Larger high-quality studies are necessary to guide practice in this difficult area. © 2015 The Association of Coloproctology of Great Britain and Ireland.
Agency: European Commission | Branch: FP7 | Program: CP-FP | Phase: NMP.2011.1.2-3 | Award Amount: 4.85M | Year: 2012
The main objective of the CERAMPOL project is to achieve a new generation of smart and low-fouling nanostructured membranes based on ceramic and polymeric materials with enhanced affinity to heavy metals and drugs. CERAMPOL will contribute in solving issues related to waste water in metallurgic and pharmaceutical industries/hospital respectively. Moreover, by reducing the concentration of highly toxic contaminants in the water supplies, lakes, rivers, and streams, the new filtration technology developed in the CERAMPOL project will mitigate the risk to humans health and the environment such as bioaccumulation of heavy metals, the emergence of multidrug resistance organisms, chronic toxicity, and metal-related diseases. The new filters will be prepared by innovative processes such as electrospinning, sol-gel, coating processes for obtaining multi-layered membranes possessing several key properties such as: antifouling; self-cleaning; selective filtration of antibiotics and heavy metals. Specifically, the multi-layered membranes will composed of three functional parts CERAMPOL functional parts: an anti-fouling pre-filter based on polymeric nanofibers, a cleaning system based on piezoelectric materials, and a highly selective nanostructured ceramic membrane. The new filters will be scaled up at semi industrial level for in-situ water treatments in foundry, pharmaceutical and hospital effluents. The benefits of such technology will be fully characterized in terms of water filtration efficiency and economic and environmental impacts. Complete technological and economical viability assessments of the CERAMPOL technology will be carried out by the industrial partners. Environmental impact caused by the new filtration technology will be fully assessed in order to highlight benefits in terms of water preservation and recovering.
Agency: European Commission | Branch: FP7 | Program: CP-TP | Phase: EeB.NMP.2013-3 | Award Amount: 13.68M | Year: 2013
RESEEPE will bring together design and decision making tools, innovative building fabric manufacturers and a strong demonstration programme to demonstrate the improved building performance through retrofitting. The core idea of the RESSEEPE project is to technically advance, adapt, demonstrate and assess a number of innovative retrofit technologies. Reductions in the area of 50% will be achieved in terms of energy consumption .A systemic process will be also implemented that will allow the selection of the best possible retrofiting mix, customised to the needs of the particular building.. Several remarkable innovative technologies and materials will be integrated in the retrofitting process: - Envelope Retrofitting: Ventilated Facades, Aerogel-based Superinsulating mortar, Wooden Insulating Wall Panel and VIP Panel - Integration of RES: PV Energy, Thermal Collectors - Energy Storage Systems: Thermal storage and PCMs - Nanotechnologies and smart materials: EC/PV Windows - ICT: Strategies at building and district level - Intelligent Building Controls: HVAC systems The RESSEEPE framework will be validated and refined by a strong demonstration programme, envisaging the renovation of 102.000 square meters of public buildings, arriving to a total renovation of 205.000 square meters that will be deployed in the following years. The estimated average of energy consumption in the renovated demo sites, on final energy, will be 66 kWh/m2year, representing a 63% of reduction in energy consumption compared to the current situation. CO2 emissions will be 48,15 kg/m2year, corresponding to more than 60 % of reduction. The total emissions avoided by the demo sites will be 2257 tCO2/year. Associated investment costs to building renovation are expected to represent a maximum of 19% on average of the total costs of building an equivalent new building in the same location. On average, the return on investment will be around 7,6 years.
Alvarez P.,Center Forum |
Urretavizcaya M.,Hospital Of Bellvitge |
Benlloch L.,Consorci Sanitari de Terrassa |
Vallejo J.,Hospital Of Bellvitge |
Menchon J.M.,Hospital Of Bellvitge
International Journal of Geriatric Psychiatry | Year: 2011
Objective Several studies have reported clinical and biological differences between early- and late-onset (EO and LO) depression, which suggest different underlying aetiological processes. The aim of the present study is to examine whether there are differences between EO and LO depressed patients with melancholy, controlling for current age, with regard to clinical variables, vascular risk factors and family history of affective disorders or suicide. Methods One hundred and twenty-one melancholic patients were divided into three groups: patients with current age and onset earlier than 60 (N = 60), patients aged 60 or over and with onset at 60 or later (N = 30) and patients aged 60 or over and with onset before the age of 60 (N = 31). Systematic clinical data were collected with the structured interview 'The Schedule for Affective Disorders and Schizophrenia'. Symptom ratings at admission and at discharge were assessed by means of the 21-item Hamilton Depression Rating Scale, the Hamilton Anxiety Scale and the Widlöcher Depression Retardation Scale. Family history of affective disorders or suicide was obtained using the Family History Research Diagnostic Criteria. Vascular risk factors were also recorded. Results The only symptoms that differed across the groups were feelings of anger and irritability, which scored lower in the LO older group. No other significant differences were found in the variables studied. Conclusion According to this study, LO depression with melancholia should not be considered as a distinct entity. Further studies on EO and LO-depression should consider this diagnostic subtype, among others, as a key variable. Copyright © 2010 John Wiley & Sons, Ltd.
Agency: European Commission | Branch: H2020 | Program: IA | Phase: PHC-20-2014 | Award Amount: 4.36M | Year: 2015
As Europes population is ageing, long-term care for elderly citizens will become an increasing cost for society. To manage this transition healthcare policies in the EU and individual Member States are heavily focussed on extending the independent life of the elderly, with the dual aim of increasing their quality of life and reducing the costs of care. Dementia affects more than 6% of people aged 60\ and has a devastating effect on their independence to date, there is no proven intervention to help dementia patients live a fulfilling life for longer. In this project we will build on an innovative patient support tool to develop a mHealth application that is specifically targeted to patients with mild dementia. The tool will help patients to adhere to their treatment and share data with their carers and doctors; carers will use the same application to monitor patients more easily and share their own well-being with doctors. This will slow the patients cognitive and functional decline, avoid carers getting exhausted and reduce costs of emergency care. Our project will comprise two phases: first we will use digital accessibility tools to re-design the existing application for dementia patients. The development will be steered by patients, carers and doctors, through user-centric design: we will collect feedback on each new version of the application until the design is perfectly adapted to the users needs. In the second phase we will pilot the optimised application with 1,100 users (patients \ carers) and 1,100 controls. This will show the clinical and social benefits for patients and carers, as well as financial benefits for the healthcare system. Successful delivery of the pilot will increase patients adherence to treatment (10 %-points), while improving the quality of life of carers and patients. It will save healthcare providers 1,818 / patient / year in care costs and will generate revenue of over 18 million / year for the consortium (Year 5).
Misky A.,University College London |
Hotouras A.,University College London |
Ribas Y.,Consorci Sanitari de Terrassa |
Ramar S.,King's College |
Bhan C.,University College London
Colorectal Disease | Year: 2016
Aim: Enterocutaneous fistula (ECF) is considered to be one of the most challenging complications a general surgeon can encounter. The current mainstay of treatment is surgical closure, associated with significant morbidity and mortality. Vacuum assisted closure (VAC) has been successfully used for closure of persistent abdominal wounds for a number of years. This study aims to investigate whether current literature supports the use of VAC for ECF. Method: A PubMed search of the search terms ‘enterocutaneous fistula’ and ‘vacuum assisted closure/therapy’ was performed in December 2014. Results were restricted to articles involving human subjects with an available abstract and full text written between 1950 and 2014. The end-points analysed included rate of fistula closure, duration of follow-up, and morbidity and mortality where available. Results: Ten studies (all level IV) including 151 patients were examined. In all except one, surgery was the underlying aetiology with median number of fistulae per patient of one. The median rate of closure with VAC was 64.6% (7.7–100%) with healing occurring within 58 (12–90) days. Follow-up was only mentioned in three of the 10 studies, in which the patients were followed for 3, 20 and 28.5 months. No complications were reported in all but one of the studies, in which abdominal wall disruption and intestinal obstruction were identified in a minority of patients. Conclusion: The included studies suggest that VAC therapy may be considered a safe treatment for ECF. The current evidence is generally of low level and characterized by heterogeneity. Definitive recommendations based on this information cannot therefore be made. Further studies are necessary to establish any proven benefit over standard surgical or conservative therapy. Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland
Ramos-Grille I.,Consorci Sanitari de Terrassa |
Ramos-Grille I.,Autonomous University of Barcelona |
Goma-i-Freixanet M.,Autonomous University of Barcelona |
Aragay N.,Consorci Sanitari de Terrassa |
And 2 more authors.
Addictive Behaviors | Year: 2015
Introduction: The aim of this study was twofold: First, to assess the personality profile of treatment-seeking adult outpatients with pathological gambling compared to a matched control group under the Alternative Five Factor Model perspective, and second, to determine which personality variables would predict treatment outcome. Methods: The final total sample consisted of 44 consecutive treatment-seeking pathological gamblers (PGs) and 88 controls paired by age and sex who completed the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ). Twelve months after starting an open program of individual cognitive-behavioral therapy, PGs were categorized as abstinent or treatment failure. Results: PGs scored significantly higher on Neuroticism-Anxiety. Those who had relapsed or dropped out showed higher Impulsivity and Sensation Seeking scores. Impulsivity emerged as a significant predictor of treatment failure. Treatment-seeking PGs scored higher on Neuroticism-Anxiety and Impulsivity appeared as a risk factor of relapsing or dropping out. Conclusions: Our findings support the importance of individual differences in personality on therapy outcomes. The ZKPQ may constitute a useful tool to identify these individual differences that might be considered when making personalized treatment decisions to improve the effectiveness and quality of treatment interventions. © 2014 Elsevier Ltd.