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Sanchis J.,University of Barcelona | Corrigan C.,Kings College London | Levy M.L.,University of Edinburgh | Viejo J.L.,Hospital Universitario Of Burgos
Respiratory Medicine

This brief overview of the factors determining lung deposition of aerosols provides background information required by health care providers when instructing patients to use their prescribed inhalers. We discuss differences in the optimal inhalation manoeuvres for each type of aerosol generator and the difficulties patients face. Provision of short, clear instructions with demonstration of critical steps and checking technique during later clinical visits are necessary if these aerosolised medications are to be fully beneficial.© 2012 Elsevier Ltd. All rights reserved. Source

Lopez-Pueyo M.J.,Hospital Universitario Of Burgos | Olaechea-Astigarraga P.,Service of Intensive Care Medicine | Palomar-Martinez M.,Hospital Universitario Arnau Of Vilanova | Insausti-Ordenana J.,Service of Intensive Care Medicine | Alvarez-Lerma F.,Service of Intensive Care Medicine
Journal of Hospital Infection

Background: Data validation is an essential aspect for the accuracy of a nosocomial infection surveillance registry. Aim: To report the results of the first quality control programme in the national surveillance programme of intensive care unit (ICU)-acquired infection in Spain (ENVIN-HELICS registry). Method: During 2008, of 13,824 records included in the database, 1500 (10.8%) registries from 20 ICUs were reviewed. These ICUs were selected at random and stratified according to the number of cases included in the registry. The proportion of infected patients, which was 9.6% [95% confidence interval (CI) 8.09-11.16], was maintained during the selection of cases for review. Two physicians were trained for the purpose of the study and undertook the review. Results: Overall sensitivity, specificity and positive and negative predictive values of the ENVIN-HELICS registry for the identification of patients with any device-related infection acquired during their ICU stay were 86.0% (95% CI 80.0-92.0), 98.7% (95% CI 82.19-93.6), 87.9% (95% CI 82.19-93.6) and 98.5% (95% CI 97.8-99.2), respectively, with a kappa index of 0.85 (95% CI 0.79-0.92). Secondary bloodstream infection had the lowest sensitivity (59.3%), and intubation-associated pneumonia had the highest sensitivity (86.3%). Conclusion: There was good correlation between data reported by the registrars and data validated by auditors, confirming the reliability of the ENVIN-HELICS registry. © 2013 The Healthcare Infection Society. Source

Frasson M.,Polytechnic University of Valencia | Flor-Lorente B.,Polytechnic University of Valencia | Rodriguez J.L.R.,Hospital Universitario Of Getafe | Granero-Castro P.,Polytechnic University of Valencia | And 5 more authors.
Annals of Surgery

Objective: To determine pre-/intraoperative risk factors for anastomotic leak after colon resection for cancer and to create a practical instrument for predicting anastomotic leak risk. Background: Anastomotic leak is still the most dreaded complication in colorectal surgery. Many risk factors have been identified to date, but multicentric prospective studies on anastomotic leak after colon resection are lacking. Methods: Fifty-two hospitals participated in this prospective, observational study. Data of 3193 patients, operated for colon cancer with primary anastomosis without stoma, were included in a prospective online database (September 2011-September 2012). Forty-two pre-/intraoperative variables, related to patient, tumor, surgical procedure, and hospital, were analyzed as potential independent risk factors for anastomotic leak (60-day follow-up). A nomogram was created to easily predict the risk of anastomotic leak for a given patient. Results: The anastomotic leak rate was 8.7%, and widely varied between hospitals (variance of 0.24 on the logit scale). Anastomotic leak significantly increased mortality (15.2% vs 1.9% in patients without anastomotic leak, P < 0.0001) and length of hospitalization (median 23 vs 7 days in uncomplicated patients, P < 0.0001). In the multivariate analysis, the following variables were independent risk factors for anastomotic leak: obesity [P = 0.003, odds ratio (OR) = 2.7], preoperative serum total proteins (P = 0.03, OR = 0.7 per g/dL), male sex (P = 0.03, OR = 1.6), ongoing anticoagulant treatment (P = 0.05, OR = 1.8), intraoperative complication (P = 0.03, OR = 2.2), and number of hospital beds (P = 0.04, OR = 0.95 per 100 beds). Conclusions: Anastomotic leak after colon resection for cancer is a frequent, relevant complication. Patients, surgical technique, and hospital are all important determining factors of anastomotic leak risk. © 2015 Wolters Kluwer Health, Inc. Source

Objective: To determine the requirements to become a wet nurse for the rich class, mainly at the Court, from the 17th century to the 19 th century; the social consideration of maternal breastfeeding and wet nurse breastfeeding; the wet nurse social relevance and the reasons to hire them, as well as the knowledge about the female reproductive cycle and physiology of lactation. Material and methods: A bibliographical investigation of printed documents, royal decrees, orphanage documentation, and medical, historical, gynecology, hygiene and ways of life books of the centuries mentioned. Results: There was a huge demand of wet nurses on the society due to medical and socioeconomical reasons. The wet nurses were very important so they received great number of praises, but were also strongly criticized; in fact, from the 17th century, a medical current that proclaims the advantages of maternal breastfeeding begins, and considers wet nurses as the worst of the society. The requirements to become a wet nurse in the high class, and especially at the Court, were very strict. The origin, the physical and moral characteristic, the social conditions and the milk quality and amount were considered. Conclusions: The knowledge about physiological changes of the female body and the child social class determinate the wet nurse characteristics. The perfect nurse had good morality, medium constitution and medium breasts, was healthy, blond or dark-haired, and proceeded from a little town. This work gives us the chance to continue researching in this way. ©2013 Ediciones Mayo, S.A. All rights reserved. Source

Delgado-Lopez P.D.,Hospital Universitario Of Burgos | Corrales-Garcia E.M.,Hospital Universitario Of Burgos
Clinical and Translational Oncology

Glioblastoma (GBM) is the most common and lethal tumor of the central nervous system. The natural history of treated GBM remains very poor with 5-year survival rates of 5 %. Survival has not significantly improved over the last decades. Currently, the best that can be offered is a modest 14-month overall median survival in patients undergoing maximum safe resection plus adjuvant chemoradiotherapy. Prognostic factors involved in survival include age, performance status, grade, specific markers (MGMT methylation, mutation of IDH1, IDH2 or TERT, 1p19q codeletion, overexpression of EGFR, etc.) and, likely, the extent of resection. Certain adjuncts to surgery, especially cortical mapping and 5-ALA fluorescence, favor higher rates of gross total resection with apparent positive impact on survival. Recurrent tumors can be offered re-intervention, participation in clinical trials, anti-angiogenic agent or local electric field therapy, without an evident impact on survival. Molecular-targeted therapies, immunotherapy and gene therapy are promising tools currently under research. © 2016 Federación de Sociedades Españolas de Oncología (FESEO) Source

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