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Martin M.C.,Hospital Universitario Of Torrejon | Leon C.,University of Seville | Cunat J.,Hospital Universitario La Paz | Del Nogal F.,Servicio de Medicina Intensiva
Medicina Intensiva | Year: 2013

Objectives: To identify the resources related to the care of critically ill patients in Spain, which are available in the units dependent of the Services of Intensive Care Medicine (ICM) or other services/specialties, analyzing their distribution according to characteristics of the hospitals and by autonomous communities. Design: Prospective observational study. Setting: Spanish hospitals. Participants: Heads of the Services of ICM. Main outcome variables: Number of units and beds for critically ill patients and functional dependence. Results: The total number of registries obtained with at least one Service of ICM was 237, with a total of 100,198 hospital beds. Level iii (43.5%) and level ii (35%) hospitals predominated. A total of 73% were public hospitals and 55.3% were non-university centers. The total number of beds for adult critically ill patients, was 4,738 (10.3/100,000 inhabitants). The services of ICM registered had available 258 intensive are units (ICUs), with 3,363 beds, mainly polyvalent ICUs (81%) and 43 intermediate care units. The number of patients attended in the Services of ICM in 2008 was 174,904, with a percentage of occupation of 79.5%. A total of 228 units attending critically ill patients, which are dependent of other services with 2,233 beds, 772 for pediatric patients or neonates, were registered. When these last specialized units are excluded, there was a marked predominance of postsurgical units followed by coronary and cardiac units. Conclusions: Seventy one per cent of beds available in the Critical Care Units in Spain are characterized by attending severe adult patients, are dependent of the services of ICM, and most of them are polyvalent. © 2013 Elsevier España, S.L. and SEMICYUC. Source

Lledin Barbancho L.,Medico adjunto del Servicio de Hepatologia y Trasplante hepatico | Vecino Lopez R.,Hospital Universitario Of Torrejon
Pediatria Integral | Year: 2015

Symptomatology of gastrointestinal disease is a very common cause of pediatric consultation in the clinical practice. The majority of cases are not important processes and need no further diagnostic laboratory or imaging work-up. The main challenge for paediatricians is to detect those cases that need them. The approach to the evaluation of children with hepatobiliary disease may occasionally be a difficult task. Therefore, a thorough history and clinical examination is mandatory, focusing on key findings that may ultimately lead to diagnosis. An accurate interpretation of laboratory and radiological tests, as well as a rationale use of the latter has to be the rule in this context. Here we review in a clear, brief and practical presentation the most important diagnostic tests in liver disease, its advantages and limitations © 2015, Ediciones Ergon SA. All Righrts Reserved. Source

Eimil-Ortiz M.,Hospital Universitario Of Torrejon
Medicina Paliativa | Year: 2016

Objectives: To review medical literature regarding the implementation of Palliative care (PC) in acute stroke and to analyze its theoretical and practical framework: definition, criteria and screening tools developed for referral, patients ´profile and major needs and comparison between different palliative care patients. Methods: In order to achieve our goal, a systematic research was conducted using public data bases: PubMed, Tripdatabase, Embase. Terms employed: ". palliative care AND stroke", ". end of life AND stroke", ". advanced care directives AND stroke", ". neuro-critical AND acute stroke". We accepted all kind of articles published until september 1st 2015. Through a comprehensive reading of the articles, the following categories of papers were rejected: clinical cases, articles on basic sciences, other illness besides acute stroke, and those articles regarding chronic states. In order to achieve clarity in the exposition, bibliography was expanded if needed. 291 articles were evaluated. After reading abstracts and expanding bibliography with cross-references if needed, 29 articles formed the basis for this review. Conclusions: PC applied to acute stroke is similar to PC applied to other diseases. The needs of patients focus on symptomatic relief (dyspnea, respiratory secretions, pain, agitation), but they presented as differentiating factors a lower perception of imminent death by the family, doubts about the prognosis of patients, coexistence of potentially curativetreatment and high mortality, existence of communication problems and on nutrition and other ethical considerations. Tools for easy sreening usually include severity of stroke and age. The management of PC sometimes lies on specific teams but also on professionals who work in the stroke unit with special concern about this approach. An accepted approach implements the theoretical framework of the tradicional palliative care in potentially curable patients. © 2016 Sociedad Española de Cuidados Paliativos. Source

Resano Barrio P.,Hospital Universitario Of Guadalajara | Cabezon Gutierrez L.,Hospital Universitario Of Torrejon
Medicina Paliativa | Year: 2015

Cancer pain is a complex and highly important problem in daily clinical practice. Although cancer is usually painless in the early phases of its development, the prevalence of chronic pain is 30%-50% in cancer patients undergoing active treatment and 79%-90% in patients with advanced disease. The true prevalence of breakthrough cancer pain is unclear and varies widely across studies, ranging from 19% to 93%. Dyspnea is a highly frequent symptom that is common to many diseases, indicating its multisystemic origin. This symptom can occur in respiratory and non-respiratory diseases. Dyspnea is present in up to 78% of patients with lung cancer. We describe two clinical cases in which fentanyl pectin nasal spray was used in the management of both breakthrough cancer pain and dyspnea exacerbations, providing strong symptomatic relief in both patients. © 2015 Sociedad Española de Cuidados Paliativos. Publicado por Elsevier España, S.L.U. Todos los derechos reservados. Source

Casares Santiago M.,Hospital Universitario Of Torrejon | Garcia-Tutor E.,Hospital Universitario Guadalajara | Rodriguez Caravaca G.,Hospital Universitario Fundacion Alcorcon | Del Cerro Gonzalez J.,Hospital Universitario Guadalajara | And 2 more authors.
European Radiology | Year: 2014

Objectives: Preoperative planning of deep inferior epigastric perforator (DIEP) flaps has become increasingly important in radiology services as multidetector CT angiography (CTA) has been proven to be the technique of choice. We aim to optimise the process, checking the value of the "Navarra criteria," assessing radiological and surgical concordance. Methods: Preoperative CTA was obtained in 105 DIEP flaps involving 101 women (mean age 49.1 years). A main perforator pedicle and an alternative were chosen, applying a modification of the "Navarra criteria," assessing the correlation between the main perforator chosen by the radiologist and the one that was ultimately used to perform the flap using the Kappa index. Results: In 100 of the 105 DIEP flaps (95.2 %), the perforator pedicles chosen were ultimately used to raise the flap. Four of the perforator pedicles that were not used were dismissed due to avoidable errors in the radiological approach. Concordance was very high, with a Kappa index of 0.93 (95 % CI: 0.87-0.99). CT room time was less than 12 minutes, and reading time was 10 minutes. Conclusions: The application of the "Navarra criteria" in preoperative planning of DIEP flaps improves radiological and surgical concordance as well as the reading process. Key Points: • DIEP flap is one of the best techniques for breast reconstruction. • Preoperative planning is essential in DIEP flaps. • CTA is the best option for the preoperative planning of DIEP flaps. • "Navarra criteria" allow radiologists to choose the best perforator to form flaps. • Modified "Navarra criteria" improves radiological and surgical concordance. © 2014 European Society of Radiology. Source

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