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Healthcare staff as promoters of parental presence at anesthetic induction:net Promoter Score survey

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World Journal of Clinical pediatrics 2021年第6期10卷 159-167页

作者： María Velayos Karla Estefanía María Alvarez María C Sarmiento Lucas Moratilla Pascual Sanabria Francisco Hernández Manuel V López Santamaría servicio de Cirugía pediátrica Hospital Universitario La PazMadrid 28046Spain servicio de Anestesia y Reanimación Infantil Hospital Universitario La PazMadrid 28046Spain

BACKGROUnD Surgical intervention is usually a traumatic event that causes stress and anxiety in the pediatric patient and the family environment.To reduce the harmful effects of presurgical anxiety,parental presence during induction of anesthesia(PPIA)is one of the more notable interventions used in medical centers.However,data on this measure are difficult to evaluate and often face resistance from healthcare staff.AIM To analyze the perception of the healthcare workers after the implementation of a PPIA program.METHODS A survey was developed and sent by email to all the healthcare staff working in the children’s area of a tertiary hospital.It consisted of 14 items divided into positive aspects of PPIA and negative aspects of PPIA evaluated with the use of a Likert scale(1 to 5).The demographics of the respondents were included in the data collected.The answers to the questions were interpreted through the net Promoter Score(nPS).The statistical analysis compared the differences in the responses to each question of the survey made by the different groups of health personnel included.RESULTS A total of 141 surveys were sent out,with a response rate of 69%.Of the total number of responses,68%were from women and 32%from men.The average age of the participants was 42.3±10.6 years.As for the positive questions about the PPIA,83%had an nPS>50,and only one had a score between 0 and 50,which means that the quality of the service was rated as excellent or good by 100%of the respondents.On the other hand,100%of the negative questions about the PPIA had a negative nPS.Responses to the question“PPIA increases patient safety”were significantly different(P=0.037),with a lower percentage of pediatric surgeons(70%)thinking that PPIA increased patient safety,compared with anesthesiologists(90%),nursing(92%),and other medical personnel(96%).COnCLUSIOn The personnel who participated in the PPIA program at our center were in favor of implementation.There were no validated arguments to support worker resistance to the development of

关键词： Parental presence Survey Anesthesia induction Patient-centered care Anxiety Surgery

Cardiovascular prevention in elderly patients

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Journal of Geriatric Cardiology 2022年第5期19卷 377-392页

作者： Clara Bonanad Rosa Fernández-Olmo Sergio García-Blas Jose Antonio Alarcon Pablo Díez-Villanueva Carmen Rus Mansilla Héctor García-Pardo Pablo Toledo Ana Ayesta Eva Pereira Antoni Carol Almudena Castro-Conde Carmen de Pablo-Zarzoso Manuel Martínez-Sellés Vicente Arrarte Raquel Campuzano Albert Ariza-Solé servicio de Cardiología Hospital Clínico Universitario de ValenciaValenciaSpain Instituto de Investigación Sanitaria InCLIVA ValenciaSpain servicio Cardiología Hospital Universitario de Jaén Spain servicio Cardiología Hospital de Donosti Spain servicio de Cardiología Hospital Universitario La Princesa de MadridSpain servicio de Cardiología Hospital Alto Gudalquivir de AndújarJaénSpain servicio de Cardiología Hospital Rio Hortega de ValladolidSpain servicio Cardiología Hospital Clínico San Cecilio de Granada Spain servicio de Cardiología Hospital Universitario Central de AsturiasSpain servicio de Cardiologia Hospital de LugoSpain servicio de Cardiología Hospital Moisés Broggi de BarcelonaSpain servicio de Cardiología Hospital Universitario de la Paz de Madrid Spain servicio de Cardiología Hospital Ramón y Cajal de MadridSpain department of Cardiology.Hospital Universitario Gregorio Marañón CIBERCV.Universidad EuropeaUniversidad Compluten servicio de Cardiología del Hospital General de Alicante Spain servicio de Cardiología Hospital Universitario Fundación de Alcorcón de MadridSpain servicio de Cardiología Hospital Bellvitge de BarcelonaBioheartGrup de Malalties CardiovascularsInstitut d’InvestigacióBiomèdica de BellvitgeIDIBELLL’Hospitalet de LlobregatBarcelonaSpain

In recent decades,life expectancy has been increasing significantly.In this scenario,health interventions are ne-cessary to improve prognosis and quality of life of elderly with cardiovascular risk factors and cardiovascular disease.However,the number of elderly patients included in clinical trials is low,thus current clinical practice guidelines do not include specific re-commendations.This document aims to review prevention recommendations focused in patients≥75 years with high or very high cardiovascular risk,regarding objectives,medical treatment options and also including physical exercise and their inclusion in cardiac rehabilitation programs.Also,we will show why geriatric syndromes such as frailty,dependence,cognitive impair-ment,and nutritional status,as well as comorbidities,ought to be considered in this population regarding their important pro-gnostic impact.

关键词： prevention patients cardiovascular

Impact of an acute hemodynamic response-guided protocol for primary prophylaxis of variceal bleeding

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World Journal of Clinical Cases 2018年第13期6卷 611-623页

作者： José Ignacio Fortea ángela Puente Patricia Ruiz Iranzu Ezcurra Javier Vaquero Antonio Cuadrado María Teresa Arias-Loste Joaquín Cabezas Susana Llerena Paula Iruzubieta Carlos Rodríguez-Lope Patricia Huelin Fernando Casafont Emilio Fábrega Javier Crespo servicio de Aparato Digestivo Hospital Universitario Marques? de Valdecilla Instituto de Investigación Sanitaria Marqués de Valdecilla Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas Laboratorio de Investigación en Hepatología y gastroenterología Hospital General Universitario Gregorio Mara?ón-Instituto de Investigación Sanitaria Gregorio Mara?ón

AIM To evaluate the long-term outcome of an acute hemodynamic response-guided protocol in which acute responders to intravenous propranolol received traditional nonselective beta-blockers(nSBBs) and acute nonresponders received carvedilol.METHODS Retrospective review of a protocol for primary prophylaxis of variceal bleeding guided by the acute hemodynamic response to intravenous propranolol. Fifty-two acute responders treated with traditional nSBB(i.e. propranolol or nadolol) were compared with 24 acute nonresponders receiving carvedilol. A second hemodynamic study was performed in 27 and 13 patients, respectively. The primary endpoint was development of first or further decompensation. Secondary endpoints included death from any cause, association between acute and chronic hemodynamic response, and baseline clinical and laboratory variables related to the acute hemodynamic response.RESULTS Acute responders and acute nonresponders presented similar 1, 2, and 3-year probabilities of first decompensation(nSBB: 0%, 13.7%, 26.1% vs carvedilol: 0%, 20%, 20%, P = 0.968) or further decompensation(21.2%, 26.1%, 40.9% vs 21.2%, 50.0%, 50.0%, P = 0.525). A previous episode of hepatic encephalopathy was the only independent predictor of decompensation [hazard ratio(95% confidence interval): 8.03(2.76-23.37)]. Mortality rates were similar in acute responders and acute nonresponders with compensated(P = 0.428) or decompensated cirrhosis(P = 0.429). no clinical, laboratory, endoscopic or hemodynamic parameter predicted the acute hemodynamic response. In patients receiving traditional nSBB, the acute and chronic changes of hepatic venous pressure gradient were correlated(r = 0.59, P = 0.001). Up to 69.2% of acute nonresponders gained chronic response with carvedilol.COnCLUSIOn Early identification and treatment with carvedilol of acute nonresponders to intravenous propranolol improves the clinical outcome of this high-risk group of patients, probably due to its greater effects for reducing portal pressure.

关键词： Gastrointestinal hemorrhage Propranolol Carvedilol Liver cirrhosis Portal hypertension

A review of Helicobacter pylori diagnosis, treatment, and methods to detect eradication

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World Journal of gastroenterology 2014年第6期20卷 1438-1449页

作者： Elvira Garza-González Guillermo Ignacio Perez-Perez Héctor Jesús Maldonado-Garza Francisco Javier Bosques-Padilla servicio de gastroenterología y departamento de Patología Clínica Hospital Universitario "Dr. José Eleuterio González" Universidad Autónoma de Nuevo León departments of Medicine and Microbiology New York University School of Medicine

Helicobacter pylori(H. pylori) affects nearly half of the world's population and, thus, is one of the most frequent and persistent bacterial infections worldwide. H. pylori is associated with peptic ulcer disease, gastric ulcers, mucosa-associated lymphoid tissue lymphoma, and gastric cancer. Various diagnostic methods exist to detect infection, and the choice of one method or another depends on several factors, such as accessibility, advantages and disadvantages of each method, cost, and the age of patients. Once H. pylori infection is diagnosed, the clinician decides whether treatment is necessity, according to the patient's clinical condition. Typically, eradication of H. pylori is recommended for treatment and prevention of the infection. Cure rates with the standard triple therapy are acceptable, and effective quadruple therapies, sequential therapies, and concomitant therapies have been introduced as key alternatives to treat H. pylori infection. In this work, we review the main diagnostic methods used to identify H. pylori infection and to confirm eradication of infection. In addition, key factors related to treatment are reviewed.

关键词： Diagnosis Helicobacter pylori Treatment Hybrid the

Therapeutic alternatives for the treatment of type 1 hepatorenal syndrome: A delphi technique-based consensus

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World Journal of Hepatology 2016年第25期8卷 1075-1086页

作者： Juan P Arab Juan C Claro Juan P Arancibia Jorge Contreras Fernando Gomez Cristian Munoz Leyla nazal Eric Roessler Rodrigo Wolff Marco Arrese Carlos Benítez departamento de gastroenterología Escuela de Medicina Pontificia Universidad Católica de Chile departamento de Medicina Interna and Programa de Salud Basada en la Evidencia Escuela de Medicina Pontificia Universidad Católica de Chile Sección de gastroenterología Departamento de Medicina Hospital Clínico Universidad de Chile and Clínica Santa María Unidad de gastroenterología Universidad del Desarrollo Clínica Alemana servicio de Gastroentero-logía Unidad de Trasplante Hepático Hospital del Salvador Facultad de Medicina Universidad de Chile and Unidad de Gastroenterología Clínica Alemana de Santiago Clínica Indisa Clínica Las Condes y servicio de gastroenterología Hospital Fuerza Aérea de Chile departamento de nefrología Facultad de Medicina Pontificia Universidad Católica de Chile

AIM To propose several alternatives treatment of type 1 hepatorenal syndrome(HRS-1) what is the most severe expression of circulatory dysfunction on patients with portal hypertension.METHODS A group of eleven gastroenterologists and nephrologists performed a structured analysis of available literature.Each expert was designated to review and answer a question.They generated draft statements for evaluation by all the experts.Additional input was obtained from medical community.In order to reach consensus,a modified three-round delphi technique method was used.According to United States Preventive Services Task Force criteria,the quality of the evidence and level of recommendation supporting each statement was graded.RESULTS nine questions were formulated.The available evidence was evaluated considering its quality,number of patients included in the studies and the consistency of its results.The generated questions were answered by the expert panel with a high level of agreement.Thus,a therapeutic algorithm was generated.The role of terlipressin and norepinephrine was confirmed as the pharmacologic treatment of choice.On the other hand the use of the combination of octreotide,midodrine and albumin without vasoconstrictors was discouraged.The role of several other options was also evaluated and the available evidence was explored and discussed.Liver transplantation is considered the definitive treatment for HRS-1.The present consensus is an important effort that intends to organize the available strategies based on the available evidence in the literature,the quality of the evidence and the benefits,adverse effects and availability of the therapeutic tools described.COnCLUSIOn Based on the available evidence the expert panel was able to discriminate the most appropriate therapeutic alternatives for the treatment of HRS-1.

关键词： Hepatorenal syndrome delphi Consensus Evidence-based medicine Treatment

Arrhythmogenic cardiomyopathy with left ventricular involvement versus ischemic heart disease: lessons learned from the family study and the reviewed autopsy of a young male

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Forensic Sciences Research 2019年第3期4卷 274-279页

作者： Pilar Molina Jorge Sanz-Sánchez Manuel Fenollosa Marina Martínez-Matilla Juan Giner Esther Zorio servicio de Patología Instituto de Medicina Legal y Ciencias Forenses de ValenciaValenciaEspana Unidad de Valoración del Riesgo de Muerte Súbita Familiar and Unidad de Cardiopatías Familiares Muerte Súbita y Mecanismos de Enfermedad(CaFaMuSMe)Instituto de Investigación Sanitaria La FeValenciaEspana servicio de Cardiología Hospital Universitario y Politécnico La FeValenciaEspana Unidad Genómica Instituto de Investigación Sanitaria La FeValenciaEspana

Ischemic heart disease (IHD) is the leading cause of sudden cardiac death (SCD) and often non-thrombosed severe coronary stenoses with or without myocardial scars are detected.Left dominant arrhythmogenic cardiomyopathy (LDAC) is a life-threating rare disease which has been more thoroughly studied in the last 10years.The macroscopic study of an SCD victim was conducted and re-evaluated 9years later.The cardiological work-up in his firstdegree relatives initially comprised an electrocardiogram (ECG) and an echocardiogram.When they were re-evaluted 9years later,a cardiac magnetic resonance,an ECG-monitoring,an exercise testing and a genetic study were performed and the pedigree was extended accordingly.In 2008,an IHD was suspected in the sports-triggered SCD of a 37-year-old man upon the postmortem (75% stenosis of the left main and circumflex coronary arteries;the subepicardial left ventricular fibrofatty infiltration with mild myocardial degeneration was assumed to be a past myocardial infarction).no cardiomyopathy was identified in any of the two proband's sisters.nine years thereafter,distant relatives were diagnosed with LDAC due to a pathogenic desmoplakin mutation.The reanalysis of the two sisters showed ventricular arrhythmias in one of them without structural heart involvement and the reviewed postmortem of the proband was reclassified as LDAC based on the fibrofatty infiltration;both were mutation carriers.The completion of the family study on 19 family members yielded one SCD due to LDAC (the proband),three living patients diagnosed with LDAC (two with a defibrillator),one mutation carrier without structural ventricular involvement,and 14 healthy relatives (who were discharged) with a very good co-segregation of the mutation.Although rare,LDAC exists and sometimes its differential diagnosis with iHD has to be faced.Modifying previous postmortem misdiagnoses can help family screening to further prevent SCDs.

关键词： Forensic sciences forensic pathology ischemic heart disease arrhythmogenic cardiomyopathy family study

Promising diagnostic biomarkers of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: From clinical proteomics to microbiome

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World Journal of Hepatology 2021年第11期13卷 1494-1511页

作者： Carolina Castillo-Castro Alexandro JoséMartagón-Rosado Rocio Ortiz-Lopez Luis Felipe Garrido-Treviño Melissa Villegas-Albo Francisco Javier Bosques-Padilla Tecnológico de Monterrey Escuela de Medicina y Ciencias de la SaludMonterrey 64710Mexico Unidad de Investigación de Enfermedades Metabólicas Instituto Nacional de Ciencias Médicas y NutriciónCiudad de México 14080Mexico Centro Regional para el Estudio de las Enfermedades Digestivas Servicio de GastroenterologíaFacultad de Medicina y Hospital Universitario Dr.JoséEleuterio GonzálezUniversidad Autónoma de Nuevo LeónMonterrey 64460Mexico

Fatty liver has been present in the lives of patients and physicians for almost two centuries.Vast knowledge has been generated regarding its etiology and consequences,although a long path seeking novel and innovative diagnostic biomarkers for nonalcoholic fatty liver disease(nAFLD)and nonalcoholic steatohepatitis(nASH)is still envisioned.On the one hand,proteomics and lipidomics have emerged as potential noninvasive resources for nAFLD diagnosis.In contrast,metabolomics has been able to distinguish between nAFLD and nASH,even detecting degrees of fibrosis.On the other hand,genetic and epigenetic markers have been useful in monitoring disease progression,eventually functioning as target therapies.Other markers involved in immune dysregulation,oxidative stress,and inflammation are involved in the instauration and evolution of the disease.Finally,the fascinating gut microbiome is significantly involved in nAFLD and nASH.This review presents state-of-the-art biomarkers related to nAFLD and nASH and new promises that could eventually be positioned as diagnostic resources for this disease.As is evident,despite great advances in studying these biomarkers,there is still a long path before they translate into clinical benefits.

关键词： Fatty liver Biomarkers nonalcoholic fatty liver disease nonalcoholic steatohepatitis

Effectiveness of sacubitril-varsartan versus angiotensin converting enzyme inhibitors in patients hospitalized for acute heart failure:a retrospective cohort study of the RICA registry

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Journal of Geriatric Cardiology 2022年第11期19卷 802-810页

作者： Llanos Soler-Rangel Manuel Méndez-Bailón JoséPérez-Silvestre JoséMaría Fernández-Rodríguez Beatriz Cuesta García Adrián Argüelles-Curto Álvaro González-Franco Alicia Conde-Martel Sara Carrascosa-García Marta Sánchez-Marteles JoséManuel Cerqueiro-González noel Lorenzo-Villalba Manuel Montero-Pérez-Barquero Llanos Soler-Rangel Servicio de Medicina InternaHospital Universitario Infanta SofíaFIIB HUIS HHENMadridSpain servicio de Medicina Interna Hospital Clínico San CarlosInstituto de Investigación San Carlos(IdISSC)Spain servicio de Medicina Interna Consorcio Hospital General Universitario de ValenciaSpain servicio de Medicina Interna Hospital Carmen y Severo OchoaCangas del NarceaAsturiasSpain servicio de Medicina Interna Hospital Universitario Central de AsturiasOviedoSpain servicio de Medicina Interna Hospital Universitario de Gran Canaria Dr NegrínSpain servicio de Medicina Interna Hospital Clínico Universitario Lozano Blesa de ZaragozaZaragozaSpain Hospital Universitario Lucus Augusti de Lugo LugoSpain Service de Médecine Interne Diabète et Maladies MétaboliquesHôpitaux Universitaires de StrasbourgFrance servicio de Medicina Interna IMIBIC/Hospital Universitario Reina SofíaCórdobaSpain

BACKGROUnD Sacubitril-valsartan has been shown to reduce hospitalizations and mortality in patients with heart failure(HF)and reduced ejection fraction.The PIOnEER-HF trial demonstrated that initiation of the drug during acute HF hospitalization reduced nT-proBnP levels and a post-hoc analysis of the trial found a reduction in HF hospitalizations and deaths.Real-life studies in the elderly population are scarce.The aim of our study was to assess the effectiveness of sacubitril-valsartan versus angiotensin converting enzyme inhibitors(ACEI)in elderly patients who initiate this treatment during hospitalization for acute HF.METHODS We conducted a retrospective cohort study using the Spanish acute heart failure registry(RICA)comparing rehospitalizations and deaths at 3 months and 1 year among patients aged 70 years or older who had initiated treatment with sacubitrilvalsartan during hospitalization for acute HF versus those treated with ACEI.RESULTS One hundred and ninety-nine patients hospitalized between October 2016 and november 2020 were included,with a median age of 82 years and high rate of comorbidity.Of these,107 were treated with sacubitril-valsartan and 92 with ACEI.The adjusted OR for readmission for HF at 3 months was 0.906(95%CI:0.241-3.404)and for the combined variable readmission for HF or death at 3 months was 0.696(95%CI:0.224-2.167).The adjusted OR for HF readmission at one year was 0.696(95%CI:0.224-2.167).and for the combined variable HF readmission or death at one year 0.724(95%CI:0.325-1.612).COnCLUSIOn Treatment with sacubitril-valsartan initiated early in hospitalization for HF in elderly patients with high comorbidity was associated with a trend towards a reduction in readmissions and death due to HF compared to treatment with ACEI,which did not reach statistical significance either at 3 months or 1 year of follow-up.

关键词： patients initiated admission

Refractory hepatic encephalopathy in a patient with hypothyroidism: Another element in ammonia metabolism

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World Journal of gastroenterology 2017年第28期23卷 5246-5252页

作者： Fernando Díaz-Fontenla Marta Castillo-Pradillo Arantxa Díaz-Gómez Luis Ibanez-Samaniego Pilar Gancedo Juan Adan Guzmán-de-Villoria Pilar Fernández-García Rafael Banares-Canizares Rita García-Martínez Unidad de Hepatología Servicio de Aparato DigestivoHospital General Universitario Gregorio Maranón Instituto de Investigación Sanitaria Hospital Gregorio Maranón servicio de Aparato Digestivo Hospital Santa Bárbara servicio de Radiodiagnóstico Hospital General Universitario Gregorio Maranón Centro de Investigación Biomédica en Red de Salud Mental Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas Facultad de Medicina Universidad San Pablo CEU

Hepatic encephalopathy(HE) remains a diagnosis of exclusion due to the lack of specific signs and symptoms. Refractory HE is an uncommon but serious condition that requires the search of hidden precipitating events(i.e.,portosystemic shunt) and alternative diagnosis. Hypothyroidism shares clinical manifestations with HE and is usually considered within the differential diagnosis of HE. Here,we describe a patient with refractory HE who presented a large portosystemic shunt and post-ablative hypothyroidism. Her cognitive impairment,hyperammonaemia,electroencephalograph alterations,impaired neuropsychological performance,and magnetic resonance imaging and spectroscopy disturbances were highly suggestive of HE,paralleled the course of hypothyroidism and normalized after thyroid hormone replacement. There was no need for intervention over the portosystemic shunt. The case findings support that hypothyroidism may precipitate HE in cirrhotic patients by inducing hyperammonaemia and/or enhancing ammonia brain toxicity. This case led us to consider hypothyroidism not only in the differential diagnosis but also as a precipitating factor of HE.

关键词：肝的 encephalopathy 甲状腺机能减退认知缺陷肝硬化 Portosystemic 分流磁性的回声光谱学