Palomar M.,Autonomous University of Barcelona |
Palomar M.,Hospital Universitari Arnau Of Vilanova |
Alvarez-Lerma F.,Autonomous University of Barcelona |
Riera A.,Hospital Universitari Vall dHebron |
And 6 more authors.
Critical Care Medicine | Year: 2013
Objective: Prevention of catheter-related bloodstream infection is a basic objective to optimize patient safety in the ICU. Building on the early success of a patient safety unit-based comprehensive intervention (the Keystone ICU project in Michigan), the Bacteremia Zero project aimed to assess its effectiveness after contextual adaptation at large-scale implementation in Spanish ICUs. Design: Prospective time series. Setting: A total of 192 ICUs throughout Spain. Patients: All patients admitted to the participating ICUs during the study period (baseline April 1 to June 30, 2008; intervention period from January 1, 2009, to June 30, 2010). Intervention: Engagement, education, execution, and evaluation were key program features. Main components of the intervention included a bundle of evidence-based clinical practices during insertion and maintenance of catheters and a unit-based safety program (including patient safety training and identification and analysis of errors through patient safety rounds) to improve the safety culture. Measurements and Main Results: The number of catheter-related bloodstream infections was expressed as median and interquartile range. Poisson distribution was used to calculate incidence rates and risk estimates. The participating ICUs accounted for 68% of all ICUs in Spain. Catheter-related bloodstream infection was reduced after 16-18 months of participation (median 3.07 vs 1.12 episodes per 1,000 catheter-days, p < 0.001). The adjusted incidence rate of bacteremia showed a 50% risk reduction (95% CI, 0.39-0.63) at the end of the follow-up period compared with baseline. The reduction was independent of hospital size and type. Conclusions: Results of the Bacteremia Zero project confirmed that the intervention significantly reduced catheter-related bloodstream infection after large-scale implementation in Spanish ICUs. This study suggests that the intervention can also be effective in different socioeconomic contexts even with decentralized health systems. Copyright © 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.
Campos B.,Hospital Universitari Arnau Of Vilanova |
Jauregui M.E.,Hospital Universitari Arnau Of Vilanova |
Marchlinski F.E.,University of Pennsylvania |
Dixit S.,University of Pennsylvania |
Gerstenfeld E.P.,University of California at San Francisco
Heart Rhythm | Year: 2015
BACKGROUND: Substrate ablation is commonly performed in patients with postinfarction cardiomyopathy and ventricular tachycardia (VT). Recognition of fragmented and late potentials during sinus rhythm is a tedious process subject to operator fatigue. OBJECTIVE: The purpose of this study was to assess the value of automated analysis to quantify electrogram fragmentation and to determine the relationship of fragmented regions to the VT isthmus. METHODS: Detailed left ventricular (LV) mapping was performed in 2 groups: (1) 14 patients with previous myocardial infarction and tolerated VT and (2) 14 controls with structurally normal hearts. In patients with VT, mid-isthmus sites were identified using entrainment mapping. Sinus rhythm endocardial LV electrograms underwent time- and frequency-domain analysis and were displayed as fragmentation or frequency maps. The region of fractionated electrograms and their relation to the VT isthmus sites were determined. RESULTS: Cutoffs for abnormal electrogram fragmentation were ventricular fractionation index ≥7 and fast Fourier transform ratio ≥ 14%, respectively. In the time domain, LV surface area with fractionated electrograms was significantly smaller than the total scar surface area (27.3% ± 7.1% vs 42.1% ± 12.3%, P <.001), yet contained 100% of VT isthmus sites. In the frequency domain, areas of abnormal fractionation occupied 9.7% 6.9% of total LV surface area and included only 60% of the VT isthmus sites. CONCLUSION: Automated electrogram fractionation analysis represents an objective tool to rapidly quantify electrogram fragmentation and guide substrate-based ablation of VT. Empiric ablation of these regions may be a new strategy for substrate-guided VT ablation. © 2015 Heart Rhythm Society. All rights reserved.
Brugues A.O.,Albert Ludwigs University of Freiburg |
Brugues A.O.,Hospital Universitari Arnau Of Vilanova
Medical Problems of Performing Artists | Year: 2011
Music performance anxiety (MPA) affects many individuals regardless of age, gender, experience, and hours of practice. In order to better understand the epidemiology of MPA, a review of the literature was done. Sixteen articles, meeting EBM criteria, were identified and analyzed. Children rarely suffer from MPA, while adolescents show symptoms similar to adults. Females are generally more affected than males. There is no relation between professional experience and performance anxiety. Great musicians such as Pau Casals and Enrico Caruso suffered from MPA. Nevertheless, students affected by MPA may decide not to become professional musicians because of their inability to cope with the devastating effects of performance anxiety. Solo performances showed higher MPA scores than ensemble performances. Despite these conclusions, long-term cohort studies with larger, homogeneous groups of subjects would be desirable, according to the evidence-based medicine criteria.
Brugues A.O.,Albert Ludwigs University of Freiburg |
Brugues A.O.,Hospital Universitari Arnau Of Vilanova
Medical Problems of Performing Artists | Year: 2011
Music performance anxiety (MPA) affects many individuals independent of age, gender, experience, and hours of practice. In order to prevent MPA from happening or to alleviate it when it occurs, a review of the literature about its prevention and treatment was done. Forty-four articles, meeting evidence-based medicine (EBM) criteria, were identified and analyzed. Performance repertoire should be chosen based on the musician's skill level, and it should be practiced to the point of automaticity. Because of this, the role of music teachers is essential in preventing MPA. Prevention is the most effective method against MPA. Several treatments (psychological as well as pharmacological) have been studied on subjects in order to determine the best treatment for MPA. Cognitive-behavioral therapy (CBT) seems to be the most effective, but further investigation is desired. Some musicians, in addition to CBT, also take β-blockers; however, these drugs should only be prescribed occasionally after analyzing the situation and considering the contraindications and possible side effects. Despite these conclusions, more randomized studies with larger, homogeneous groups of subjects would be desirable (according to the EBM criteria), as well as support for the necessity of both MPA prevention and optimized methods of treatment when it does occur.
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.
Marques L.,Hospital Universitari Arnau Of Vilanova
Allergy: European Journal of Allergy and Clinical Immunology | Year: 2010
Icatibant was successful in the prevention of angioedema after thyroid biopsy in hereditary angioedema. © 2009 John Wiley & Sons A/S.
Abal-Diaz L.,Hospital Universitari Arnau Of Vilanova |
Soria X.,Hospital Universitari Arnau Of Vilanova |
Casanova-Seuma J.M.,Hospital Universitari Arnau Of Vilanova
Actas Dermo-Sifiliograficas | Year: 2012
Scarring alopecia refers to a group of disorders of various etiologies that cause permanent hair loss. In this article, we focus on primary cicatricial alopecia, a group of diseases in which the hair follicle is the main target of the inflammatory process. These disorders are currently classified as lymphocytic, neutrophilic, or mixed according to the cells that make up the inflammatory infiltrate. The pathogenesis of the majority of these conditions is not fully understood and they may have similar clinical features, often making it necessary to perform 1 or more skin biopsies in order to reach a diagnosis. Management depends on early and accurate diagnosis and aggressive treatment in some cases in order to prevent follicular destruction and scarring. © 2011 Elsevier Espana, S.L. and AEDV. All rights reserved.
Buchleitner A.M.,Hospital Universitari Arnau Of Vilanova
Cochrane database of systematic reviews (Online) | Year: 2012
Patients with diabetes mellitus are at increased risk of postoperative complications. Data from randomised clinical trials and meta-analyses point to a potential benefit of intensive glycaemic control, targeting near-normal blood glucose, in patients with hyperglycaemia (with and without diabetes mellitus) being submitted to surgical procedures. However, there is limited evidence concerning this question in patients with diabetes mellitus undergoing surgery. To assess the effects of perioperative glycaemic control for diabetic patients undergoing surgery. Trials were obtained from searches of The Cochrane Library, MEDLINE, EMBASE, LILACS, CINAHL and ISIS (all up to February 2012). We included randomised controlled clinical trials that prespecified different targets of perioperative glycaemic control (intensive versus conventional or standard care) Two authors independently extracted data and assessed risk of bias. We summarised studies using meta-analysis or descriptive methods. Twelve trials randomised 694 diabetic participants to intensive control and 709 diabetic participants to conventional glycaemic control. The duration of the intervention ranged from just the duration of the surgical procedure up to 90 days. The number of participants ranged from 13 to 421, and the mean age was 64 years. Comparison of intensive with conventional glycaemic control demonstrated the following results for our predefined primary outcomes: analysis restricted to studies with low or unclear detection or attrition bias for infectious complications showed a risk ratio (RR) of 0.46 (95% confidence interval (CI) 0.18 to 1.18), P = 0.11, 627 participants, eight trials, moderate quality of the evidence (grading of recommendations assessment, development and evaluation - (GRADE)). Evaluation of death from any cause revealed a RR of 1.19 (95% CI 0.89 to 1.59), P = 0.24, 1365 participants, 11 trials, high quality of the evidence (GRADE).On the basis of a posthoc analysis, there is the hypothesis that intensive glycaemic control may increase the risk of hypoglycaemic episodes if longer-term outcome measures are analysed (RR 6.92, 95% CI 2.04 to 23.41), P = 0.002, 724 patients, three trials, low quality of the evidence (GRADE). Analysis of our predefined secondary outcomes revealed the following findings: cardiovascular events had a RR of 1.03 (95% CI 0.21 to 5.13), P = 0.97, 682 participants, six trials, moderate quality of the evidence (GRADE) when comparing the two treatment modalities; and renal failure also did not show significant differences between intensive and regular glucose control (RR 0.61, 95% CI 0.34 to 1.08), P = 0.09, 434 participants, two trials, moderate quality of the evidence (GRADE). We did not meta-analyse length of hospital stay and intensive care unit (ICU) stay due to substantial unexplained heterogeneity. Mean differences between intensive and regular glucose control groups ranged from -1.7 days to 2.1 days for ICU stay and between -8 days to 3.7 days for hospital stay (moderate quality of the evidence (GRADE)). One trial assessed health-related quality of life in 12/37 (32.4%) of participants in the intervention group and 13/44 (29.5%) of participants in the control group, and did not show an important difference (low quality of the evidence (GRADE)) in the measured physical health composite score of the short-form 12-item health survey (SF-12). None of the trials examined the effects of the interventions in terms of costs. The included trials did not demonstrate significant differences for most of the outcomes when targeting intensive perioperative glycaemic control compared with conventional glycaemic control in patients with diabetes mellitus. However, posthoc analysis indicated that intensive glycaemic control was associated with an increased number of patients experiencing hypoglycaemic episodes. Intensive glycaemic control protocols with near-normal blood glucose targets for patients with diabetes mellitus undergoing surgical procedures are currently not supported by an adequate scientific basis. We suggest that insulin treatment regimens, patient- and health-system relevant outcomes, and time points for outcome measures should be defined in a thorough and uniform way in future studies.
Valdivielso J.M.,Hospital Universitari Arnau Of Vilanova
Nefrologia | Year: 2011
Vascular calcification has traditionally been considered to be a passive process that was associated with advanced age, atherosclerosis, uncommon genetic diseases and some metabolic alterations such as diabetes mellitus and end-stage kidney failure. However, in the last years, vascular calcification has been proven to be an active and regulated process, similar to bone mineralisation, in which different bone-related proteins are involved. Recent results question the classic classification of vascular calcification into intimal and medial calcification, at least in capacitance arteries. Pro and anti-calcifying mechanisms play an active role in calcium deposition in vascular cells, making this area an active focus of research. The identification of therapeutic targets which can slow down the progression or even reverse vascular calcification could be an important step forward in the treatment of patients with chronic kidney disease. © 2011 Revista Nefrología. Órgano Oficial de la Sociedad Española de Nefrología.
Bringue Espuny X.,Hospital Universitari Arnau Of Vilanova
Cirugía pediátrica : organo oficial de la Sociedad Española de Cirugía Pediátrica | Year: 2010
Some series have shown a decrease in the incidence of intestinal invaginations in last years. Moreover, the recent introduction of new types of rotavirus vaccines increases the interest of invagination' s incidence. To this purpose, reliable local epidemiological data are needed. In order to ascertain the trend in the incidence of invaginations and their current value in our area we have performed a retrospective review of patients under 3 years of age with the diagnosis of intussusception and confiemes with barium enema or ultrasound examination during the past 21 years. Our results show a statistically significant decrease in the incidence rate, with an incidence rate of one year from the previous 0.82 (95% 0,78-0, 86) from an estimated incidence for 1987 of 17.74 cases per 10,000 girls and 30.04 cases per 10,000 boys, in 2008 an estimated incidence of 0.27 cases per 10,000 girls and 0.49 cases per 10,000 boys. We conclude that in our population during the dtudy period a significant decrease of invagination' sincidence has been seen, especially in patients younger than one year. The current incidence is 0.27 cases per 10,000 girls and 0.49 cases per 10,000 boys less than 3 years old.