Grau-Carmona T.,Hospital Universitario Doce Of Octubre |
Bonet-Saris A.,Intensive Care Unit |
Garcia-De-Lorenzo A.,Hospital Universitario La Paz |
Sanchez-Alvarez C.,Hospital General Universitario Reina Sofia |
And 5 more authors.
Critical Care Medicine | Year: 2015
Objective: n-3 polyunsaturated fatty acids (contained in fish oil) have been shown to beneficially influence infection rate and clinical outcomes in surgical patients probably due to their immunomodulatory action. In contrast, study results of fish oil administration in critically ill patients are controversial. The aim of this study was to investigate the effects of n-3 polyunsaturated fatty acids on the prevalence of nosocomial infections and clinical outcomes in medical and surgical critically ill patients. Design: Prospective, multicenter, randomized, comparative, double- blind study. Setting: Seventeen Spanish ICUs during 4 years. Subjects: A total of 159 medical and surgical intensive care patients with Acute Physiology and Chronic Health Evaluation II score more than or equal to 13, expected to require total parenteral nutrition for at least 5 days. Interventions: Patients received total parenteral nutrition prepared either with a lipid emulsion containing 10% fish oil or a fish oil-free lipid emulsion. The prevalence of nosocomial infections was detected during 28 days of ICU stay. Patients were followed 6 months after discharge from the ICU for length of hospital stay, hospital mortality, and 6-month mortality. Measurements and Main Results: The number of patients with nosocomial infections was significantly reduced in the fish oil-receiving group (21.0% vs 37.2%, p = 0.035) and the predicted time free of infection was prolonged (21 ± 2 vs 16 ± 2 d, p = 0.03). No significant differences were detected for ICU, hospital, and 6-month mortality. Conclusions: The results show that administration of n-3 polyunsaturated fatty acids reduces the risk of nosocomial infections and increases the predicted time free of infections in critically ill medical and surgical patients. The administration of n-3 polyunsaturated fatty acids was safe and well tolerated.
Effects of glatiramer acetate on spasticity in previously interferon-β-treated and treatment-naive patients with relapsing-remitting multiple sclerosis: A prospective, nonrandomized, open-label, uncontrolled, observational pilot study
Meca-Lallana J.E.,Hospital Universitario Virgen Of La Arrixaca |
de Mingo-Casado P.,Hospital Universitario Virgen Of La Arrixaca |
Amorin-Diaz M.,Hospital Comarcal del Noroeste |
Martinez-Navarro M.L.,Hospital General Universitario Reina Sofia |
Barreiro A.F.,Hospital Universitario Virgen Of La Arrixaca
Clinical Therapeutics | Year: 2010
Background: Treatment with interferon-β (IFN-β) has been related to worsening of muscle spasticity in patients with multiple sclerosis (MS). However, there are no specific data on the effects of glatiramer acetate (GA) on spasticity.Objective: The aim of the present study was to assess the effects of GA on spasticity in patients with relapsing-remitting MS who had been previously treated with IFN-β or were treatment naive.Methods: Two cohorts of MS patients with spasticity who were about to begin treatment with GA at the approved dosage (20 mg/d) were enrolled in the study: patients who were being switched from IFN-β due to adverse events or lack of efficacy (cohort 1) and patients who were treatment naive (cohort 2). The follow-up periods for cohorts 1 and 2 were 18 and 12 months, respectively. Patients' physical condition was assessed at baseline and at the end of follow-up using the Modified Ashworth Scale (MAS), Penn Spasm Frequency Scale (PSFS), Global Pain Score (GPS), Adductor Tone Rating Scale, Expanded Disability Status Scale (EDSS), and neurophysiologic tests (latency and amplitude of the Hoffmann reflex [H reflex] in the soleus, and ratio of maximum H reflex to maximum motor response [H/M ratio] in the lower limb). The frequency and severity of adverse events were recorded throughout follow-up, and investigators rated the causal relationship to GA (unrelated, unlikely, possibly, or probably).Results: Twenty-eight patients were included in the study, 13 in cohort 1 and 15 in cohort 2. All patients were white. Cohort 1 was 76.9% female, with a mean (SD) age of 39.85 (9.25) years; cohort 2 was 66.7% female, with a mean age of 40.73 (11.52) years. Cohort 1 had significant reductions from baseline to the end of follow-up in mean scores on the MAS for the right hemibody (from 1.85 [0.61] to 1.18 [0.60]; P = 0.002) and left hemibody (from 1.86 [0.55] to 1.27 [0.65]; P = 0.045), PSFS (from 2.00 [0.91] to 0.36 [0.81]; P = 0.002), and GPS (from 47.69 [13.94] to 24.09 [17.15] mm; P = 0.002). The changes from baseline were not significant on the mean Adductor Tone Rating Scale, EDSS, H-reflex latency or amplitude on either side, or lower-limb H/M ratio on either side. Cohort 2 had significant reductions from baseline in H-reflex latency on the left side (from 30.31 [2.44] to 28.75 [2.01]; P = 0.005) and H/M ratio on the right side (from 0.45 [0.15] to 0.35 [0.19]; P = 0.025). There were no significant changes in mean scores on the MAS for either hemibody, PSFS, GPS, Adductor Tone Rating Scale, EDSS, H-reflex latency on the right side, H-reflex amplitude on either side, or lower-limb H/M ratio on the left side. Sixteen patients experienced a total of 28 adverse events. Seven mild adverse events were considered related to GA: local reaction at the injection site (3 patients); headache/migraine, anxiety, and skin reaction (1 patient each); and an unspecified adverse drug reaction (1 patient). Two serious adverse events (pyelonephritis and pyrexia) occurred during the study, neither of them considered related to GA.Conclusions: In this pilot study in patients with relapsing-remitting MS, GA treatment did not increase spasticity. Furthermore, the results suggest that GA may reduce spasticity in patients previously treated with IFN-β. These findings support the conduct of large randomized controlled trials of the effects of GA on spasticity. © 2010 Excerpta Medica Inc.
Martin-Brufau R.,University of Murcia |
Corbalan-Berna J.,University of Murcia |
Ramirez-Andreo A.,Hospital General Universitario Reina Sofia |
Brufau-Redondo C.,Hospital General Universitario Reina Sofia |
Liminana-Gras R.,University of Murcia
European Journal of Dermatology | Year: 2010
Itching is common to many skin disorders. The relationship between skin disease and psychological variables has been widely documented in the literature. The association between the exacerbation of skin lesions and increased levels of psychopathological conditions in response to stressful events has also been described. Lichen Simplex Chronicus (LSC) is a skin disorder characterized by itching, which seems to have a marked psychological component. However, examples of empirical evidence linking this skin disorder to personality variables, as measured by standardized personality questionnaires, are relatively few so far. The objective of this research was to investigate the involvement of certain personality variables in the development of LSC. The personality profiles of 60 patients with LSC were compared to a normative sample of the normal Spanish population, who were free of any kind of skin disease. The personality variables for the LSC group were obtained by administering the Millon Index of Personality Styles (MIPS). Participants with LSC presented personality characteristics that differed from the control group. The most significant variables were as follows: greater tendency to pain-avoidance, greater dependency on other peoples' desires, and more conforming and dutiful compared to the control group. Results are discussed in the light of other dermatological pathologies that might share some characteristics with LSC subjects. Lichen simplex chronicus patients may present differential personality characteristics that could be related to triggering and exacerbating skin lesions. Therefore, it is relevant to evaluate the personality profiles of these people to increase treatment efficiency.
Ruzafa-Martinez M.,University of Murcia |
Lopez-Iborra L.,Hospital Universitario Virgen Of La Arrixaca |
Madrigal-Torres M.,Hospital General Universitario Reina Sofia
Journal of Evaluation in Clinical Practice | Year: 2011
Background A readiness assessment for identifying and measuring variables that can facilitate evidence-based nursing (EBN) is important. Attitude towards EBN is one of its components. However, questionnaires that exclusively measure attitude to EBN do not exist in Spanish-speaking contexts. Aim This paper is a report of the development and psychometric testing of a Spanish-language assessment tool: the Evidence-Based Nursing Attitude Questionnaire (EBNAQ). Methods The questionnaire was developed in three phases: item generation through a review of scientific literature and focus groups; item selection through an expert review; content and construct validity testing, and internal consistency reliability testing. The instrument was validated in terms of construct validity by a factorial analysis and content validity by grouping the items into the three categories of attitude: cognitive, affective and behavioural. Data were collected from May to November of 2008. Results The questionnaire was validated in a sample of 219 Spanish community nurses, who had a mean age of 43.21 (SD 10.3) years, and 64.5% (141) were women. A total of 54.3% (121) had been working in the community for more than 10 years. The questionnaire consisted of 15 items grouped into the three factors that make up the concept of attitude. Cronbach's alpha was 0.853 for the entire questionnaire. The factor solution explained 54.70% of the variance. Conclusions The EBNAQ is brief, making it a user-friendly tool. It is the first Spanish-language questionnaire that exclusively measures attitude towards EBN in nurses who work in the community. The EBNAQ can be used efficiently in research and practice settings to better understand nurses' attitudes towards evidence-based practice. © 2011 Blackwell Publishing Ltd.
Analysis of the drug interactions associated to domiciliary drug therapy in elderly hospitalized patients [Análisis de las interacciones medicamentosas asociadas a la farmacoterapia domiciliaria en pacientes ancianos hospitalizados]
Iniesta-Navalon C.,Hospital General Universitario Reina Sofia |
Urbieta-Sanz E.,Hospital General Universitario Reina Sofia |
Gascon-Canovas J.J.,University of Murcia
Revista Clinica Espanola | Year: 2011
Objective: To determine the prevalence of potentially relevant drug-drug interactions associated with chronic treatment of elderly patients over 64-years of age on hospital admission and the factors associated with an increased presence of these. Subjects and methods: Cross-sectional observational study in a hospital referral area. All patients aged 65 or over admitted to the hospital in the last three months in 2009 were included. Based on the drug database of the General Council of Colleges of Pharmacy (BOT), drug-drug interactions and their potential clinical relevance were identified. To identify the variables associated with a higher prevalence of drug-drug interactions, analyses of correlation and of univariable linear regression and uni-and multivariable logistic regression analyses were performed using the SPSS, version 15.0. Results: We analyzed the drug prescription data of 382 patients, whose mean age was 7.7 years. A total of 45.3% of patients had comorbidities and 78.8% had taken 5 or more drugs. We identified 272 clinically relevant drug-drug interactions that involved 159 patients (41.6%). Seven pharmacological groups accounted for 80.6% of the drug-drug interactions. The variables that had a statistically significant association to a higher prevalence of relevant interactions were polypharmacy, respiratory insufficiency, and treatment with proton-pump inhibitors, vitamin K antagonists, diuretics or anti-platelet drugs. Conclusions: A high prevalence of relevant drug-drug interactions was found in elderly hospitalized patients. Our findings suggest that prevention strategies should be implemented to avoid their associated adverse events, especially in high risk populations. © 2010 Elsevier España, S.L. All rights reserved.
A guide to good practice for information security in the handling of personal health data by health personnel in ambulatory care facilities [Guía de buenas prácticas de seguridad informática en el tratamiento de datos de salud para el personal sanitario en atención primaria]
Sanchez-Henarejos A.,University of Murcia |
Fernandez-Aleman J.L.,University of Murcia |
Toval A.,University of Murcia |
Hernandez-Hernandez I.,Hospital General Universitario Reina Sofia |
And 2 more authors.
Atencion Primaria | Year: 2014
The appearance of electronic health records has led to the need to strengthen the security of personal health data in order to ensure privacy. Despite the large number of technical security measures and recommendations that exist to protect the security of health data, there is an increase in violations of the privacy of patients' personal data in healthcare organizations, which is in many cases caused by the mistakes or oversights of healthcare professionals. In this paper, we present a guide to good practice for information security in the handling of personal health data by health personnel, drawn from recommendations, regulations and national and international standards. The material presented in this paper can be used in the security audit of health professionals, or as a part of continuing education programs in ambulatory care facilities. © 2013 Elsevier España, S.L. All rights reserved.
Fernandez Aleman J.L.,University of Murcia |
Hernandez I.,Hospital General Universitario Reina Sofia |
Sanchez Garcia A.B.,University of Murcia |
Sanchez Garcia A.B.,Hospital General Universitario Reina Sofia
Gaceta Sanitaria | Year: 2013
Objective: To identify the opinions of patients of the Murcia Health Service on the adoption of personal health records (PHRs) and the factors associated with these opinions. Methods: A cross sectional and descriptive study was performed by personal survey of a sample of individuals (N=156) aged between 14 and 80 years old in five public health facilities of districts VI and VII of the Health Service of Murcia. Results: A total of 87.8% of the population stated they would use PHRs. Respondents aged 24-33 years old were 13.15 times more willing to use PHRs (95% CI: 1.09-157.42) than people over 63 years old. A lower probability of using PHRs was found in people who did not use the Internet, with an odds ratio of 0.31 (95% CI: 0.07-1.29); this difference was not statistically significant. Conclusions: Most of the patients surveyed had never heard of PHRs but most would be willing to use them. © 2012 SESPAS.
Sanchez Alvarez C.,Hospital General Universitario Reina Sofia
Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral | Year: 2011
Gastrointestinal surgery and critical illness place tremendous stress on the body, resulting in a series of metabolic changes that may lead to severe malnutrition, which in turn can increase postsurgical complications and morbidity and mortality and prolong the hospital length of stay. In these patients, parenteral nutrition is the most widely used form of nutritional support, but administration of enteral nutrition early in the postoperative period is effective and well tolerated, reducing infectious complications, improving wound healing and reducing length of hospital stay. Calorie-protein requirements do not differ from those in other critically-ill patients and depend on the patient's underlying process and degree of metabolic stress. In patients intolerant to enteral nutrition, especially if the intolerance is due to increased gastric residual volume, prokinetic agents can be used to optimize calorie intake. When proximal sutures are used, tubes allowing early jejunal feeding should be used. Pharmaconutrition is indicated in these patients, who benefit from enteral administration of arginine, omega 3 and RNA, as well as parenteral glutamine supplementation. Parenteral nutrition should be started in patients with absolute contraindication for use of the gastrointestinal tract or as complementary nutrition if adequate energy intake is not achieved through the enteral route.
Diaz-Manzano J.A.,Hospital Clinico Universitario Virgen Of La Arrixaca |
Pelegrin-Hernandez J.P.,Hospital Clinico Universitario Virgen Of La Arrixaca |
Minguez-Merlos N.,Hospital Clinico Universitario Virgen Of La Arrixaca |
Cegarra-Navarro M.F.,Hospital General Universitario Reina Sofia
International Journal of Pediatric Otorhinolaryngology | Year: 2014
Cervical lymphatic malformation is an infrequent benign congenital malformation of the lymphatic system, whose rapid growing capacity can compromise the airway. Here we present a 3-month-old male with severe respiratory impairment showing pharyngeal, cervical and mediastinal lymphatic malformation. Transoral surgery maintaining the mucosa allowed removal of numerous cystic lumps occupying the whole pharynx up to the pyriform sinus, surrounding the common carotid artery. Postsurgical MRI showed that the pharynx portion of the lymphatic malformation had disappeared. We conclude that the oropharyngeal approach is an alternative to the classical external surgery involving upper respiratory tract compression. © 2014 Elsevier Ireland Ltd.
Invasive radiologic management of hemodialysis fistulas: Measuring flow with an endovascular catheter [Manejo radiológico invasivo de las fístulas de hemodiálisis midiendo el flujo con un catéter endovascular]
Garcia-Medina J.,Hospital General Universitario Reina Sofia
Radiologia | Year: 2015
Objectives To analyze the values of flow obtained with an endovascular catheter, and to determine whether they are more reliable than angiographic and clinical findings for planning and for determining the outcome of invasive radiologic treatment of hemodialysis fistulas, as well as to determine the safety of this technique during interventional radiology procedures. Material and methods We used endovascular catheters to measure flow in 341 vascular accesses for hemodialysis (162 [47.6%] distal fistulas, 132 [38.4%] humeral fistulas, and 47 [14%] arteriovenous grafts) in 598 procedures (a total of 3,051 flow measurements). Dysfunction was most commonly due to high pressures and flow deficits. Results The catheter was used to measure the results of radiologic treatment in 419 (70%) cases and only to measure the control of flow in the hemodialysis access in 179 (30%) cases. In the cases where lesions of the access had been treated radiologically, the flow improved by a mean of 1,232 ml/min. In 2 (0.35%) cases, the tip of the catheter perforated the wall of the vein; this complication was resolved by inflating a low pressure balloon. Conclusions Endovascular catheters are useful for measuring flow in invasive vascular radiology procedures for hemodialysis. In assessing the hemodynamic status of a vascular access, they are most helpful in determining whether stenosis is present. © 2013 SERAM.