McNicholas T.A.,University of Hertfordshire |
Woo H.H.,University of Sydney |
Chin P.T.,Figtree Private Hospital |
Bolton D.,Austin Hospital |
And 7 more authors.
European Urology | Year: 2013
Background: Many men with benign prostatic hyperplasia (BPH) are dissatisfied with current treatment options. Although transurethral resection of the prostate (TURP) remains the gold standard, many patients seek a less invasive alternative. Objective: We describe the surgical technique and results of a novel minimally invasive implant procedure that offers symptom relief and improved voiding flow in an international series of patients. Design, setting, and participants: A total of 102 men with symptomatic BPH were consecutively treated at seven centers across five countries. Patients were evaluated up to a median follow-up of 1 yr postprocedure. Average age, prostate size, and International Prostate Symptom Score (IPSS) were 68 yr, 48 cm3, and 23, respectively. Surgical procedure: The prostatic urethral lift mechanically opens the prostatic urethra with UroLift implants that are placed transurethrally under cystoscopic visualization, thereby separating the encroaching prostatic lobes. Outcome measurements and statistical analysis: Patients were evaluated pre- and postoperatively by the IPSS, Quality-of-Life (QOL) scale, Benign Prostatic Hyperplasia Impact Index, maximum flow rate (Qmax), and adverse event reports including sexual function. Results and limitations: All procedures were completed successfully with a mean of 4.5 implants without serious adverse effects. Patients experienced symptom relief by 2 wk that was sustained to 12 mo. Mean IPSS, QOL, and Qmax improved 36%, 39%, and 38% by 2 wk, and 52%, 53%, and 51% at 12 mo (p < 0.001), respectively. Adverse events were mild and transient. There were no reports of loss of antegrade ejaculation. A total of 6.5% of patients progressed to TURP without complication. Study limitations include the retrospective single-arm nature and the modest patient number. Conclusions: Prostatic urethral lift has promise for BPH. It is minimally invasive, can be done under local anesthesia, does not appear to cause retrograde ejaculation, and improves symptoms and voiding flow. This study corroborates prior published results. Larger series with randomisation, comparator treatments, and longer follow-up are underway. © 2013 European Association of Urology.
Casado J.,Hospital Universitario Del Henares |
Montero M.,University of Cordoba, Spain |
Formiga F.,Hospital Universitario Of Bellvitge |
Carrera M.,Complejo Hospitalario Of Soria |
And 3 more authors.
European Journal of Internal Medicine | Year: 2013
Background Renal dysfunction is common in patients with heart failure (HF) and is associated with high mortality. This relationship is well established in HF and reduced ejection fraction (HFREF), however, it is not fully understood in HF and preserved ejection fraction (HFPEF). The aim of this study was to determine the impact of renal dysfunction on all-cause mortality in HFPEF patients and to evaluate the clinical characteristics of patients that deteriorate renal function in the first year of follow-up. Methods We evaluated the patients with HFPEF included in the RICA registry. This is a multi-center and prospective cohort study that includes patients admitted for decompensated HF. Estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN) and plasma creatinine concentrations were used for renal function assessment at admission and after one year of follow up. Results A total of 455 patients (mean age 78 ± 8.1 years; 62% women) were included, of whom 265 (58.2%) had eGFR < 60 mL/min/1.73 m2. After adjustment for covariates, only lower admission eGFR remained significantly predictive of all-cause mortality (HR 2.97; 95% CI 1.59-5.53). After one year of follow-up 16.6% of patients deteriorated at least 25% of eGFR. These patients were more likely to be diabetic (54.5% vs 42.6%; p = 0.039) and had a higher rate of prescription of mineralcorticoid receptor antagonist (MRA) agents (47% vs 23.3%; p < 0.001). Conclusion Renal dysfunction is frequently associated with HFPEF. eGFR below normal is strongly associated with mortality. Further decline of renal function is frequent especially among diabetic and patients treated with MRA agents. © 2013 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
Zea-Sevilla M.A.,Carlos III Institute of Health |
Bermejo-Velasco P.,Hospital Puerta Of Hierro |
Serrano-Heranz R.,Hospital Universitario Del Henares |
Calero M.,Carlos III Institute of Health |
Calero M.,CIBER ISCIII
Journal of Alzheimer's Disease | Year: 2015
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a rare inherited cerebrovascular disease associated with mutations in the NOTCH3 gene on chromosome 19, and represents the most common hereditary stroke disorder. We describe a pedigree, which suffered the classical clinical CADASIL pattern of migraine headaches, recurrent subcortical infarcts, and subcortical dementia, associated with a previously undescribed missense mutation (c.[244T>C], p.[C82R]) in NOTCH3. This new mutation extends the list of known pathogenic mutations responsible for CADASIL, which are associated with an odd number of cysteine residues within any of the epidermal growth factor-like repeats of Notch3 receptor protein. © 2015 IOS Press and the authors. All rights reserved.
PubMed | Autonomous University of Madrid and Hospital Universitario del Henares
Type: Journal Article | Journal: Revista espanola de cardiologia (English ed.) | Year: 2016
Prompt coronary reperfusion is crucial in patients with ST-segment elevation acute coronary syndrome. The aim of this study was to determine factors associated with a delay in seeking medical attention after the onset of symptoms in patients with this condition.Prospective cohort study in consecutive patients with ST segment elevation infarction. Multiple logistic regression analysis was used to identify factors independently associated with a longer delay in requesting medical help.In total, 444 consecutive patients were included (mean age, 63 years; 76% men, 20% with diabetes). Median total ischemia time was 225 (160-317) minutes; median delay in seeking medical attention was 110 (51-190) minutes. Older patients (age > 75 years; odds ratio = 11.6), women (odds ratio = 3.4), individuals with diabetes (odds ratio = 2.3), and those requesting medical care from home (odds ratio = 2.2) showed the longest delays in seeking medical attention. Lengthy delay was associated with higher in-hospital mortality (9.8% vs 2.7%; P<.005) and 1-year mortality (7.3% vs 2.9%; P<.05) than when attention was promptly solicited.Elderly patients, women, and diabetic individuals with ST-segment elevation myocardial infarction show longer delays in seeking medical attention for their condition. Delays in seeking medical attention are associated with greater in-hospital and 1-year mortality.
Characteristics of informal caregivers of patients with dementia in Alicante province [Red de cuidadores informales de los pacientes con demencia en la provincia de Alicante, descripción de sus características]
Toribio-Diaz M.E.,Hospital Universitario del Henares |
Medrano-Martinez V.,Hospital Virgen Of La Salud |
Molto-Jorda J.M.,Hospital Virgen Of Los Lirios |
Beltran-Blasco I.,Consulta de Neurologia
Neurologia | Year: 2013
Introduction: Informal caregivers provide care to dementia patients, and this service prolongs their stay at home. Objectives: To describe characteristics of dementia patients in the province of Alicante, as well as the profiles and roles of caregivers who assist them. Patients and methods: Multi-centre prospective study carried out in 4 neurology departments in Alicante (June 2009 to January 2010). Dementia patients' relatives/caregivers were included in sequential order. The following variables were analysed: a) Demographic information pertaining to the patient and caregivers (age, sex, marital and employment status, educational level, relationship to patient); b) patient's family unit; c) motivating factor for primary caregiver (PC); d) secondary caregiver (SC) roles; e) country of citizenship of formal caregiver (FC) and source of remuneration (private/public); f) caregivers' knowledge of dementia. Results: Most of our patients live at home (74.8%), and are female (69%) with Alzheimer's disease (78.4%) in a moderately severe stage (GDS level 4-5, 71.6%). PCs and SCs are mainly women (72.1% and 60.5% respectively), middle-aged and directly related to the patient (sons/daughters account for 64.3% of the PCs and 54.4% of the SCs); most are homemakers with a low educational level. Caregivers in the first category (PC) provide care due to moral obligation (75%), while those in the second (SC) involve patients in leisure or other stimulating activities (82.3%). Absent caregivers tend to be males (73.3%) residing long distances from the relative (52.4%). The FC tends to be female (91.7%), Spanish (81.8%) and privately remunerated. Conclusions: Women dominate the network of caregivers for dementia patients, whether as principal caregivers, supporting caregivers or formal caregivers (in all cases, they have only limited training in dementia management). Males are largely absent. Better knowledge of the care structure supporting dementia patients may be helpful in the overall management of these patients. © 2012 Sociedad Española de Neurología.
Diaz-Agero Perez C.,Hospital Universitario Ramon jal Carretera Of Colmenar |
Robustillo Rodela A.,Hospital Universitario Ramon jal Carretera Of Colmenar |
Pita Lopez M.J.,Hospital Universitario Del Henares |
Lopez Fresnena N.,Hospital Universitario Ramon jal Carretera Of Colmenar
American Journal of Infection Control | Year: 2014
Background The Indicadores Clínicos de Mejora Continua de la Calidad (INCLIMECC) program was established in Spain in 1997. Methods INCLIMECC is a prospective system of health care-associated infection (HAI) surveillance that collects incidence data in surgical and intensive care unit patients. The protocol is based on the National Healthcare Safety Network (NHSN) surveillance system, formerly known as the National Nosocomial Infection Surveillance (NNIS) system, and uses standard infection definitions from the US Centers for Disease Control and Prevention. Each hospital takes part voluntarily and selects the units and surgical procedures to be surveyed. Results This report is a summary of the data collected between January 1997 and June 2012. A total of 370,015 patients were included, and the overall incidence of surgical wound infection (SWI) was 4.51%. SWI rates are provided by NHSN operating procedure category and NNIS risk index category. More than 27% of the patients received inadequate antibiotic prophylaxis, the main reason being unsuitable duration (57.05% of cases). Conclusions Today, the INCLIMECC network includes 64 Spanish hospitals. We believe that an HAI surveillance system with trained personnel external to the surveyed unit is a key component not only in infection control and prevention, but also in a quality improvement system. Copyright © 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Garnero A.J.,Associated Health Professionals |
Abbona H.,American Association For Respiratory Care International Fellow |
Gordo-Vidal F.,Hospital Universitario del Henares |
Hermosa-Gelbard C.,Hospital Universitario del Henares
Medicina Intensiva | Year: 2013
The first generation of mechanical ventilators were controlled and cycled by pressure. Unfortunately, they did not allow control of the delivered tidal volume under changes in the dynamics of the respiratory system. This led to a second generation of ventilators that allowed volume control, hence favoring the ventilatory strategy based on normalization of the arterial gases.Studies conducted in the 1980s which related lung injury to the high ventilator pressures utilized while treating acute respiratory distress syndrome patients renewed interest in pressure-controlled mechanical ventilation. In addition, new evidence became available, leading to the development of pulmonary protective strategies aiming at preventing the progression of ventilator-induced lung injury.This review provides a detailed description of the control of pressure or volume using certain ventilatory modes, and offers a general view of their advantages and disadvantages, based on the latest available evidence. © 2012 Elsevier España, S.L. y SEMICYUC.
Gordo-Vidal F.,Hospital Universitario del Henares |
Enciso-Calderon V.,Hospital Universitario del Henares
Medicina Intensiva | Year: 2012
Mechanical ventilation in acute respiratory distress syndrome (ARDS) implies an increase in alveolar and transpulmonary pressure, giving rise to major alterations in pulmonary circulation and causing right ventricular functional overload that can lead to ventricular failure and thus to acute cor pulmonale. The condition is echocardiographically characterized by dilatation of the right ventricle and paradoxical movement of the interventricular septum, with the added alteration of left ventricular systolic function. It is important to take lung mechanical and hemodynamic monitoring into account when defining the ventilation strategy in such patients, optimizing lung recruitment without producing pulmonary over-distension phenomena that may lead to greater deterioration of right ventricle function. This approach is known as a right ventricle protective ventilation strategy. © 2011 Elsevier España, S.L. and SEMICYUC.
Gordo F.,Hospital Universitario del Henares |
Gordo F.,Francisco de Vitoria University |
Abella A.,Hospital Universitario del Henares
Medicina Intensiva | Year: 2014
The term "ICU without walls" refers to innovative management in Intensive Care, based on two key elements: (1) collaboration of all medical and nursing staff involved in patient care during hospitalization and (2) technological support for severity early detection protocols by identifying patients at risk of deterioration throughout the hospital, based on the assessment of vital signs and/or laboratory test values, with the clear aim of improving critical patient safety in the hospitalization process.At present, it can be affirmed that there is important work to be done in the detection of severity and early intervention in patients at risk of organ dysfunction. Such work must be adapted to the circumstances of each center and should include training in the detection of severity, multidisciplinary work in the complete patient clinical process, and the use of technological systems allowing intervention on the basis of monitored laboratory and physiological parameters, with effective and efficient use of the information generated. Not only must information be generated, but also efficient management of such information must also be achieved.It is necessary to improve our activity through innovation in management procedures that facilitate the work of the intensivist, in collaboration with other specialists, throughout the hospital environment. Innovation is furthermore required in the efficient management of the information generated in hospitals, through intelligent and directed usage of the new available technology. © 2014 Elsevier España, S.L.U. and SEMICYUC.
Introduction of a management system in Intensive Care Medicine based on the safety of the seriously ill patient during the entire hospitalization process: Extended Intensive Care Medicine [Implantación de un sistema de gestión en Medicina Intensiva basado en la seguridad del paciente gravemente enfermo durante todo el proceso de hospitalización: servicio extendido de Medicina Intensiva]
Calvo Herranz E.,Hospital Universitario del Henares |
Mozo Martin M.T.,Hospital Universitario del Henares |
Gordo Vidal F.,Hospital Universitario del Henares
Medicina Intensiva | Year: 2011
The clinical care of hospitalized seriously ill patients must be suitably proportionate independently of the functional unit to which they have been admitted. Most of these patients are admitted to the Intensive Care Unit (ICU), where uninterrupted management is provided, with important technological and care resources. However, hospitalization of the seriously ill patient must be understood as a continuum starting and ending beyond hospital stay. Anticipating critical worsening requiring admission to the ICU would be of benefit to the patient, avoiding greater clinical worsening, and also would be of benefit to the hospital, by allowing improved resource management.Intensivists are the professionals best suited for this purpose, since they are trained to recognize the seriousness of an always dynamic clinical situation. Addressing this task implies a change in the traditional way of working of the ICU, since a critical patient is not only a patient already admitted to the Unit but also any other patient admitted to hospital whose clinical situation is becoming destabilized. In this context, our ICU has established two strategic lines. One consists of the identification of patients at risk outside the Unit and is based on the recognition, diagnostic orientation and early treatment of the seriously ill patient, in collaboration with other clinical specialties and independently of the hospital area to which the patient has been admitted. The second line in turn comprises clinical care within the actual Unit, and is based on the promotion of safety and the vigilance of nosocomial infections. © 2011 Elsevier España, S.L. y SEMICYUC.