Purpose To describe the time, frequency, and clinical characteristics of treatment failure after I-125 brachytherapy in patients with uveal melanoma treated and followed in a Spanish referral ocular ...oncology unit. Design Prospective, consecutive, interventional case series. Methods Patients diagnosed with uveal melanoma from 1995 to 2016 and treated with episcleral brachytherapy were included. Demographic data collection, ophthalmic evaluation, ultrasound scan, and systemic studies were performed at baseline, every six months thereafter for five years, and subsequently at annual intervals. Recurrence was defined as presence of tumor growth after treatment. Baseline analysis was performed by descriptive methods and survival by Kaplan-Meier curves. Results From 732 patients diagnosed with uveal melanoma, 311 were treated with brachytherapy. In the follow-up (mean 79 months, SD=55) 16 local tumor recurrences (5.1%) were detected. All relapsing patients had choroidal tumors and 15 presented with visual symptoms. All patients were treated with I-125 brachytherapy, and two received associated transpupillary thermotherapy (TTT). All the eyes were enucleated after recurrence. Kaplan Meier analysis showed a mean time of recurrence of 3.7 years (SD=2.94, ranging from 1 to 12 years). Three patients had metastasis in the follow up. Kaplan Meier analysis showed worse survival for patients with recurrence. Conclusion Local treatment failure was a relatively infrequent event after I-125 brachytherapy in our series. Not only do recurrences appear early but also late in the follow-up. They do not have a distinctive clinical pattern and are associated with poorer survival.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Introduction:
To report the spectrum and frequency of conjunctiva tumours in an ocular oncology unit analysing the clinical profile of benign, precancerous and malignant conjunctival lesions.
...Methods:
A retrospective case series of 462 consecutive patients diagnosed at the Ocular Oncology Unit of the University Hospital of Valladolid from 1992 to 2017.
Results:
Among 462 consecutive patients, the tumour was classified as melanocytic in 252 (54.5%) and non-melanocytic in 210 (45.5). Two hundred forty-eight males (mean age 51.63 (SD = 23.20)) and 214 females (mean age 48.27 (SD = 21.77)) were included. Mean patient age at diagnosis was 50.07 years (range = 1-92 years). The majority of tumours were benign (n = 307 (66.5%)) followed by precancerous (n = 103 (22.3%)) and finally by malignant ones (n = 52 (11.3%)). Benign lesions were predominantly found in younger individuals rather than premalignant (p < 0.05) and malignant ones (p < 0.05). Most of the melanocytic lesions were benign (88.5%), most epithelial ones were precancerous (61.4%) and most lymphoid lesions were malignant (56.3%). Tumours involving one or four quadrants of the ocular surface usually were benign, unlike tumours involving three quadrants that were malignant (16 (48.5%) p < 0.05). The majority of benign lesions were detected on females (n = 163 (53.1%)) by routine examination (n = 178 (86.4%)). However, main complaint in malignant tumours was the growth of the lesion (n = 39 (76.5%)).
Conclusion:
Most of the conjunctival tumours were melanocytic, mostly benign, closely followed by those of epithelial origin, with a predominance of precancerous lesions. Melanocytic, epithelial and lymphoid tumours accounted for over 90% of cases. A trend was identified with benign lesions being found in younger female patients on routine examination.
Full text
Available for:
NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
To analyze the prevalence and management of pain episodes, their evaluation and recording in internal medicine hospitalization units in a third level public hospital of the regional health service of ...Castilla y León.
A descriptive cross-sectional study. The study population comprised patients hospitalized in internal medicine units. Pain prevalence was detected by the Brief Pain Inventory questionnaire. The management of pain episodes was analyzed as recorded in the clinical records.
83 patients were included, 73.5% of them reported pain and 67.2% did not know their analgesia regimen. More episodes of pain were identified in the women (P=.006) than in the men. The pharmacological administration was recorded in all cases; however, nurses recorded the episode in the clinical history of 29.5% of the patients. In no case, was the pain intensity or degree of relief recorded using the visual analogical scale.
There is evidence of a high prevalence of pain in hospitalized patients and deficiencies in the management of pain episodes by nurses, both in evaluation and recording. This implies the need for pain control protocols and the implementation of evidence-based best practice guidelines to provide nurses with the means and support for adequate pain management.
Increased arterial stiffness has been shown to predict cardiovascular risk in hypertensive patients. Our objective was to evaluate the relationship between the ambulatory arterial stiffness index ...(AASI) and subclinical organ damage (SOD). The design was a cross-sectional study. Subjects included 554 hypertensive patients with and without drug treatment (mean age 57±12 years, 60.6% men). The AASI was defined as 1 minus the regression slope of diastolic over systolic blood pressure (BP) readings obtained from 24-h recordings. Renal damage was evaluated on the basis of glomerular filtration rate (GFR) and microalbuminuria; vascular damage was measured by carotid intima-media thickness (IMT) and ankle/brachial index (ABI); and cardiac damage was evaluated on the basis of the Cornell voltage-duration product (VDP) and left ventricular mass index. The mean AASI was 0.38±0.07 (0.39±0.07 in treated patients and 0.37±0.06 in nontreated subjects). The AASI showed a positive correlation with IMT (r=0.417, P<0.001) and Cornell VDP (r=0.188, P<0.001), and a negative correlation with GFR (r=-0.205, P=0.001) and the ABI. The variables associated with the presence of SOD were AASI (odds ratio (OR)=3.89) and smoking (OR=1.55). The variables associated with IMT were smoking and waist circumference, whereas those associated with GFR were AASI, body mass index and waist circumference. In turn, smoking, total cholesterol and glycosylated hemoglobin A1c were associated with the ABI. Increased AASI implies a greater presence of SOD in primary hypertensive patients with or without BP-lowering drug treatment.
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
To study the efficacy and safety of different treatments for diabetic neovascular glaucoma (NVG). We additionally attempt to determine if the presence of NVG could be a predictor of cardiovascular ...disease or death.
This is a retrospective, observational cohort study including patients diagnosed with diabetic NVG from 2006 to 2016 at the Hospital Clínico Universitario de Valladolid (Spain). Extracted data included clinical characteristics of the patients, glycated haemoglobin levels, and ocular treatment. Visual acuity (VA), intraocular pressure (IOP), cardiovascular events, and deaths were registered.
30 eyes from 23 patients were followed for a mean of 4.48 years (SD = 2.82 years). The IOP-lowering intervention groups were: Ahmed implant (11 eyes), laser cyclo-photocoagulation (CPC; 6 eyes), both (4 eyes), or none (9 eyes). IOP success was achieved in 100% of the eyes with Ahmed and/or laser CPC and in 44.4% of the eyes with no IOP-lowering procedure (p= 0.002). Most eyes with Ahmed implant (with or without CPC) maintained or improved their VA (100 and 63.6%, respectively). 33.3% of the eyes with laser CPC and 25% of those with no IOP-lowering intervention maintained or improved their VA (p = 0.028). Hypotony was the only adverse effect (after laser CPC). No statistically significant difference could be established between low VA (finger count or worse), poor IOP control, or bad metabolic control and mortality or cardiovascular event (p > 0.05), however, the four patients who died had poor VA at the time of NVG diagnosis.
Ahmed implant surgery is a safe and effective treatment option for diabetic NVG. Medical treatment alone is not the best option for most cases. Advanced NVG could be an indicator of higher mortality risk in diabetic patients.
Background: Physical inactivity and sedentary lifestyle
are an emerging individual, familiar and social public
health problem. The aim of this work was to validate
a new questionnaire to know the ...attitude towards physical
activity and other habits in adolescents.
Methods: The Delphi method was used. It was developed
in three phases: an initial phase of selection of
the panel of experts, an exploratory phase in two rounds
of voting using a Likert scale of 1 to 5, and statistical and
qualitative analysis of the experts’ contributions. The criteria
for the choice of items were: average > 3.5 and factor
V of Aiken ≥ 0.7. Reliability was assessed with the
Cronbach alpha coefficient. A pilot test was carried out to
assess the understanding of the instrument.
Results: 21 experts agreed to participate. Their participation
was 100% in the first round and 95.2% in the second
one. Seven items did not meet the criteria. The final
questionnaire included 93 questions and 11 dimensions:
data of the student, father, mother, physical activity in
the educational center, transportation, free time, psychosocial
aspects of physical activity, attitude towards physical
activity, food, other habits and health perception. A
Cronbach’s alpha of 0.974 was obtained.
Conclusions: The results support the reliability and
validity of the questionnaire. The Delphi method proved
to be a useful technique for the proposed objective.
Fundamentos: La inactividad física y el sedentarismo
son un problema de salud pública emergente, tanto
a nivel individual como familiar y social. El objetivo de
este estudio fue validar un nuevo cuestionario para conocer
la actitud ante la actividad física y otros hábitos de los
adolescentes.
Sujetos y métodos: Se utilizó el método Delphi. Se
llevó a cabo una fase inicial de selección del panel de expertos,
una fase exploratoria en dos rondas de votación
mediante escala tipo Likert (de 1 a 5), y un análisis estadístico
y cualitativo de las aportaciones de los expertos.
Los criterios para la elección de ítems fueron un promedio
mayor a 3,5 y V de Aiken mayor o igual a 0,7. La fiabilidad
se valoró con el coeficiente alfa de Cronbach. Se
realizó una prueba piloto para valorar la comprensión del
instrumento.
Resultados: Aceptaron participar 21 expertos. Su
participación fue del 100% en la primera ronda y del
95,2% en la segunda. Siete ítems incumplieron los criterios.
El cuestionario final contó con 93 preguntas y 11
dimensiones: datos sobre el alumno, el padre, la madre, la
actividad física en el centro educativo, en el transporte y
en el tiempo libre, sobre los aspectos psicosociales de la
práctica de actividad física, la actitud ante la actividad física,
la alimentación y otros hábitos, y sobre la percepción
de salud. Se obtuvo un alfa de Cronbach de 0,974.
Conclusiones: Los resultados avalan la fiabilidad y
validez del cuestionario. El método Delphi resultó ser una
técnica útil para el objetivo propuesto.
Resumen Objetivo El hospital de día supone una alternativa asistencial a la hospitalización convencional. Durante el año 2009 se realizó un análisis del funcionamiento y la rentabilidad del hospital ...de día del Hospital Clínico de Valladolid, España. Expresamos la rentabilidad como la prestación de una idéntica cobertura sanitaria a un menor coste generado respecto a la hospitalización convencional y cumpliendo unos indicadores de calidad. Métodos Estudio de tipo retrospectivo, transversal, observacional y descriptivo, sobre la información obtenida de cada paciente atendido en el hospital de día, entre el 1 de enero y el 31 de diciembre de 2009. Se determinaron cuatro indicadores de calidad: la determinación de la cancelación de sesiones, la tasa de reacciones transfusionales, el índice de ambulatorización y el índice de satisfacción. El ahorro estimado de cada proceso atendido resulta de la diferencia del coste medio por proceso en hospitalización menos el coste medio del proceso en hospital de día. Resultados La patología más prevalente fueron las enfermedades sistémicas y del tejido conectivo, que representan el 25,4%; de ellas, el 17,1% corresponde a artritis reumatoide. La satisfacción global de los pacientes es del 93%, la cancelación de sesiones y la tasa de reacciones transfusionales fue del 0%, y el índice de ambulatorización de un 26%. Los costes del hospital de día representan el 8,6% de los costes generados en la hospitalización convencional, con un ahorro de 78.390,69 euros. Conclusión El hospital de día es rentable, debido al ahorro generado respecto a la hospitalización convencional, a la vez que consigue unos adecuados índices de calidad.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
To analyse the prevalence and management of pain episodes, their evaluation and recording in internal medicine hospitalisation units in a third level public hospital of the regional health service of ...Castilla y León.
A descriptive cross-sectional study. The study population comprised patients hospitalized in internal medicine units. Pain prevalence was detected by the Brief Pain Inventory questionnaire. The management of pain episodes was analysed as recorded in the clinical records.
83 patients were included, 73.5% of them reported pain and 67.2% did not know their analgesia regimen. More episodes of pain were identified in the women (P=.006) than in the men. The pharmacological administration was recorded in all cases; however, nurses recorded the episode in the clinical history of 29.5% of the patients. In no case, was the pain intensity or degree of relief recorded using the visual analogical scale.
There is evidence of a high prevalence of pain in hospitalized patients and deficiencies in the management of pain episodes by nurses, both in evaluation and recording. This implies the need for pain control protocols and the implementation of evidence-based best practice guidelines to provide nurses with the means and support for adequate pain management.
Analizar la prevalencia y el manejo de los episodios de dolor, su evaluación y registro en unidades de hospitalización de Medicina Interna en un hospital público de tercer nivel del Servicio Regional de Salud de Castilla y León.
Estudio descriptivo transversal sobre los pacientes ingresados en unidades de Medicina Interna. La prevalencia del dolor se detectó mediante el cuestionario Brief Pain Inventory. La gestión de los episodios se analizó mediante su registro en la historia clínica.
Se incluyeron 83 pacientes, el 73,5% manifestaron dolor y el 67,2% desconocían su pauta analgésica. Se identificaron más episodios de dolor en el caso de las mujeres (p=0,006) con respecto a los hombres. La administración farmacológica se registró en todos los casos, el episodio de dolor dentro del evolutivo de la enfermera se registró en el 29,5% y en ningún caso se registró intensidad o grado de alivio con la Escala Visual Analógica, en la gráfica de constantes.
Se ha evidenciado una alta prevalencia de dolor en los pacientes hospitalizados y una deficiencia en la gestión de los episodios de dolor por parte de las enfermeras, tanto en la evaluación como en el registro. Ello implica la necesidad de protocolizar el control del dolor implementando buenas prácticas basadas en la evidencia y dotar a las enfermeras de los medios y el apoyo necesario para poder realizar un manejo adecuado del dolor.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The objective of this study was to evaluate the impact of echinocandins and fluconazole) on mortality 7 and 30 days after candidemia onset and overall in-hospital mortality), in patients with ...candidemia at a Spanish tertiary hospital.
A retrospective study was conducted that enrolled all non-neutropenic adult patients diagnosed with candidemia at Hospital Clínico Universitario de Valladolid between 2007 and 2016. A total of 179 patients were evaluated, they were divided into two sub-groups: surviving patients (n = 92) and non-surviving patients (n = 87).
The 7-day mortality was 25,1% (45), 30-day mortality was 46,9% (84), and overall in-hospital mortality was 48,6% (87). 40.8% of patients received no antifungal treatment (43.8% of surviving patients and 37.8% of non-surviving patients; p=0.15). A total of 106 (59.2%) patients were treated, of which 90 patients (50.3%) received empiric treatment. 19.6% and 47.8% of surviving patients were treated with echinocandins and fluconazole, respectively. By contrast, of non-surviving patients, 31.0% were treated with echinocandins and 47.1% received fluconazole. Survival for the first 7 days was significantly higher in treated with antifungal agents (log-rank = 0.029), however, there were not significant differences in 30-day survival. Factors linked to a significant increase in overall in-hospital mortality were age (OR 1.040), septic shock (OR 2.694) and need for mechanical ventilation > 48 h (OR 2.812).
Patients who received antifungal treatment, regardless of whether they received fluconazole or echinocandins, had a significantly lower mortality rate after 7 days than untreated patients, although no significant differences in 30-day mortality were seen.
PDF
