•CerTest and Panbio Ag-RDTs are reliable to diagnose SARS-CoV-2 infection.•Their sensitivity was over 90 % for samples with a Ct≤25.•Their sensitivity was over 84 % within 5 days after the onset of ...symptoms.•Specificity of both assays was 100 %. Agreement between them was excellent.•Agreement with PCR was also excellent for samples with Ct≤25.
Antigen rapid diagnostic tests (Ag-RDT) have been developed as reliable tools to control the SARS-CoV-2 pandemic. The objective of our study was to evaluate the diagnostic performance of two Ag-RDTs.
We evaluated CerTest SARS-CoV-2 Ag One Step Card Test and Panbio COVID-19 Ag Rapid Test Device Ag-RDTs. We included 320 nasopharyngeal samples: 150 PCR negative samples to assess the specificity and 170 PCR positive samples to evaluate the sensitivity. We also evaluated their sensitivity according to cycle threshold (Ct) values and the time from the onset of symptoms. Tests were compared using the McNemar’s test and agreement was evaluated using the kappa score (k).
Both Ag-RDTs showed a specificity of 100 %. Overall sensitivity was 53.5 % for CerTest and 60.0 % for Panbio. For samples with Ct≤ 25, sensitivity was 94.0 % for CerTest and 96.4 % for Panbio (p = 0.500). Regarding samples with Ct>25, sensitivity was 14.0 % for CerTest and 24.4 % for Panbio (p = 0.004). Sensitivity for samples within the first 5 days after the onset of symptoms were 84.8 % for CerTest and 91.3 % for Panbio (p = 0.250) and notably decreased for samples taken after the fifth day. Both Ag-RDTs showed an excellent agreement between them (agreement = 96.7 %, k = 0.920). Agreement with PCR was also excellent for high viral load samples (Ct<25) for CerTest (98.0 %, k = 0.954) and Panbio (98.8 %, k = 0.973).
CerTest SARS-CoV-2 and Panbio COVID-19 Ag showed excellent performance and agreement results for samples with high viral loads (Ct ≤ 25) or samples taken within the first 5 days after the onset of symptoms.
Early appropriate antibiotic treatment is essential in sepsis. We aimed to evaluate the impact of a multifaceted educational intervention to improve antibiotic treatment. We hypothesized that the ...intervention would hasten and improve the appropriateness of empirical antibiotic administration, favor de-escalation, and decrease mortality.
We prospectively studied all consecutive patients with sepsis/septic shock admitted to 72 intensive care units (ICUs) throughout Spain in two 4-month periods (before and immediately after the 3-month intervention). We compared process-of-care variables (resuscitation bundle and time-to-initiation, appropriateness, and de-escalation of empirical antibiotic treatment) and outcome variables between the two cohorts. The primary outcome was hospital mortality. We analyzed the intervention's long-term impact in a subset of 50 ICUs.
We included 2628 patients (age 64.1 ± 15.2 years; men 64.0%; Acute Physiology and Chronic Health Evaluation (APACHE) II, 22.0 ± 8.1): 1352 in the preintervention cohort and 1276 in the postintervention cohort. In the postintervention cohort, the mean (SD) time from sepsis onset to empirical antibiotic therapy was lower (2.0 (2.7) vs. 2.5 (3.6) h; p = 0.002), the proportion of inappropriate empirical treatments was lower (6.5% vs. 8.9%; p = 0.024), and the proportion of patients in whom antibiotic treatment was de-escalated was higher (20.1% vs. 16.3%; p = 0.004); the expected reduction in mortality did not reach statistical significance (29.4% in the postintervention cohort vs. 30.5% in the preintervention cohort; p = 0.544). Gains observed after the intervention were maintained in the long-term follow-up period.
Despite advances in sepsis treatment, educational interventions can still improve the delivery of care; further improvements might also improve outcomes.
La adición de fósforo (P) en el líquido de hemodiálisis (LD) mediante enema con fosfato de sodio (enema Casen®) se utiliza habitualmente en pacientes con hipofosforemia. El cálculo de la cantidad y ...los problemas que puede presentar no se describen en la literatura. Nuestro trabajo hace un abordaje práctico de cómo poner fósforo en LD con una fórmula razonada para calcular cuánto volumen de enema añadir en función del concentrado de diálisis utilizado y los problemas que pueden aparecer.
The addition of phosphorus (P) to the dialysate (LD) in the form of enema Casen® is common practice in patients with hypophosphatemia. The estimation of the amount to be used and the identification of the problems that may can occur are not well defined. As a result of our work we propose a practical approach of how to proceed to increase phosphate concentration in the hemodialysate. We present a reasoned formula to calculate how much enema has to be added and the problems that may arise.
Retirada de benzodiacepinas en el anciano Álvarez Ruiz de Larrinaga, Ainhoa; Agustí Visiedo, Juan José; Valiño Colas, Mª Jesús ...
Revista de neurologiá,
2022, Letnik:
74, Številka:
7
Journal Article
The addition of phosphorus (P) to the dialysate (LD) in the form of enema Casen® is common practice in patients with hypophosphatemia. The estimation of the amount to be used and the identification ...of the problems that may occur are not well defined. As a result of our work we propose a practical approach of how to proceed to increase phosphate concentration in the hemodialysate. We present a reasoned formula to calculate how much enema has to be added and the problems that may arise.
Abstract
Background
Outpatient parenteral antibiotic treatment (OPAT) programs are increasingly used to manage infective endocarditis (IE), but current criteria for indicating OPAT are markedly ...conservative. We aimed to investigate whether more liberal criteria for indicating OPAT in IE can be safely used.
Methods
This was a prospective multicenter nationwide cohort study (2008–2018). Rates of readmission, recurrences, and 1-year mortality were compared between hospital-based antibiotic treatment (HBAT) and OPAT. Risk factors for readmission and mortality in OPAT patients were investigated by logistic regression. Patients did not fulfill OPAT-GAMES (Grupos de Apoyo al Manejo de la Endocarditis en ESpaña) criteria if they had any of the following: cirrhosis, severe central nervous system emboli, undrained abscesses, severe conditions requiring cardiac surgery in nonoperable patients, severe postsurgical complications, highly difficult-to-treat microorganisms, or intravenous drug use.
Results
A total of 2279 HBAT patients and 1268 OPAT patients were included. Among OPAT patients, 307 (24.2%) did not fulfill OPAT-GAMES criteria. Overall, OPAT patients presented higher rates of readmission than HBAT patients (18.2% vs 14.4%; P = .004), but no significant differences were found in the propensity analysis. Patients not fulfilling OPAT-GAMES criteria presented significantly higher rates of readmission than HBAT and OPAT-GAMES (23.8%, 14.4%, 16.4%; P < .001), whereas no significant differences were found in mortality (5.9%, 8%, 7.4%; P = .103) or recurrences (3.9%, 3.1%, 2.5%; P = .546). Not fulfilling OPAT-GAMES criteria was associated with higher risk of readmission (odds ratio OR, 1.43; 95% CI, 1.03–1.97; P = .03), whereas cardiac surgery was associated with lower risk (OR, 0.72; 95% CI, 0.53–0.98; P = .03).
Conclusions
OPAT-GAMES criteria allow identification of IE patients at higher risk of long-term complications to whom OPAT cannot be safely administered.
Prediabetes and not just diabetes can cause kidney damage. This study assess the association of prediabetes with development of impaired renal function (IRF). We used data from PREDAPS prospective ...study a cohort of 1072 subjects with prediabetes and another cohort of 772 subjects without prediabetes were follow-up from 2012 to 2017. Prediabetes was defined according to American Association of Diabetes criteria. IRF was defined as having a glomerular filtration rate < 60 mL/min/1.73 m
. Incidence rates of IRF in both cohorts and in different categories of prediabetes, based on impaired glycosylated hemoglobin (HbA1c) and/or fasting plasma glucose (FPG), were calculated. Hazard ratios (HR) for the association of the prediabetes with IRF, adjusting for potential confounders, were estimated by Cox regression models. Incidence rates of IRF per 100 person-years were 1.72 (95% confidence interval CI: 1.34-2.21) and 1.79 (95%CI: 1.45-2.20) for those without and with prediabetes, respectively .The HR of IRF in subjects with prediabetes with respect to subjects without prediabetes was 0.76 (95% CI: 0. 54-1.07). Corresponding HRs for type of prediabetes was 0.68 (95%CI: 0.40-1.15) for those with both altered parameters, 0.68 (95%CI: 00.40-1.15) for those with only impaired HbA1c and 1.12 (95%CI: 0.68-1.85) for those with only impaired FPG. The present study reflects an overall trend towards a slightly decreased risk of IRF onset associated to prediabetes except for individuals with only isolated impaired FPG. Further studies are warranted to fully assess the renal progression of each group.
Newborn Screening Programs (NSP) in Spain were born in the
city of Granada in 1968. Till the 1980s, they were developed around
the so-called “National Plan for Preventing Subnormality”, covering
up ...to 30% of the Spanish newborns. From 1982, when the health
system management was transferred to the different autonomous regions,
the NSP began to expand, and the bases to transform them into
an organized and multidisciplinary activity, integrated and coordinated
from the National Health System were settled. Despite this expansion,
it is not until the 1990s when their coverage reaches almost
100% newborns in Spain.
NSP grew up asymmetrically across the different autonomous
regions. In 2005 and 2006 the scientific societies SEQC (Spanish
Society of Clinical Chemistry) and AECNE (Spanish Society of
Newborn Screening), coordinated by the Health Promotion Area of
the General Directorate of Public Health, gathered together the necessary
information to elaborate a report on the NSP in Spain addressed
to the Interterritorial Council of the National Health System. In July
2013, that Council approved the seven diseases that should be part of
each region newborn screening panel, being the first step towards the
NSP harmonization in Spain. Currently, the NSP include between 8
and 29 diseases in their panels, thus more still more efforts are needed
in order to achieve a higher uniformity.
Los Programas de Cribado Neonatal (PCN) nacen en España en
Granada en el año 1968. Posteriormente, y hasta los años 80, se fueron
desarrollando en torno al llamado “Plan Nacional de Prevención
de la Subnormalidad” con una cobertura cercana al 30% de los recién
nacidos españoles. A partir de 1982, con el inicio de la gestión de
la sanidad a las comunidades autónomas (CCAA), los PCN se expandieron
y se comenzaron a sentar las bases para que éstos se convirtieran
en una actividad organizada y multidisciplinar, integrados y
coordinados desde el Sistema de Salud. A pesar de dicha expansión
no es hasta el inicio de la década de los 90 cuando se consigue una
cobertura próxima al 100% de los RN en España.
Los PCN fueron creciendo de forma muy asimétrica en las diferentes
CCAA y en los años 2005 y 2006 las Sociedades Científicas
SEQC (Sociedad Española de Química Clínica) y AECNE
(Asociación Española de Cribado Neonatal), con la coordinación
del Área de Promoción de la Salud de la Dirección General de Salud
Pública, recopilaron la información y elaboraron un informe, sobre
los PCN en España para el Consejo Interterritorial del sistema
Nacional de Salud (CISNS). En julio de 2013 este Consejo aprobó
las siete enfermedades que debían formar parte del panel de detección
de los PCN territoriales, primer paso hacia la armonización de
estos programas. Actualmente, los PCN incluyen entre 8 y 29 enfermedades
por lo que es necesario seguir trabajando para conseguir una
mayor uniformidad.
Follow a recipe to prescribe phosphate during hemodialysis Albalate, Marta; Ruiz-Alvarez, Ma Jesús; de Sequera, Patricia ...
Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia,
2017 Jan - Feb, 20170101, Letnik:
37, Številka:
1
Journal Article
Recenzirano
Odprti dostop
The addition of phosphorus (P) to the dialysate (LD) in the form of enema Casen® is common practice in patients with hypophosphatemia. The estimation of the amount to be used and the identification ...of the problems that may can occur are not well defined. As a result of our work we propose a practical approach of how to proceed to increase phosphate concentration in the hemodialysate. We present a reasoned formula to calculate how much enema has to be added and the problems that may arise.
Background: The results of 5 years of experience (2004–2008) with process-based quality management using quality indicators for key laboratory processes (analytic and extra-analytic) in a group of ...clinical laboratories affiliated with the Catalan Health Institute are presented. Our purpose was to analyze the evolution of the indicators, identify processes that require corrective measures, and obtain specifica tions that are more robust than the preliminary ones proposed in a previous study by the same group. Methods: The yearly average was recorded for each indicator in each laboratory, the yearly interlaboratory median was calculated, and the changes occurring were studied to determine their continuity in the 5-year period. For each indicator, the average of the yearly medians was calculated and the results transformed to the Six Sigma scale to estimate the degree of control over the related process. It was suggested to establish the yearly interlaboratory median as the desirable specification for each indicator. Results: The medians for most indicators were stable during the period studied. Thus, the specifications proposed in the first study were considered robust in these cases. The Six Sigma statistic provided added value in this study because it enabled detection of processes that should be improved, in which case the specifications proposed were considered provisional despite their stability. After identifying processes that have the greatest impact on patient safety, the group set a specification of 0%, regardless of the actual specification obtained, although the members are conscious of the difficulty in attaining this level of quality. Certain processes that are in a period of change obtained specifications that are considered in a phase of consolidation. Conclusions: The results for indicators related with sample collection indicate that the process is stable and well controlled. However, based on the results for Hemolyzed serum sample, the group saw the need for installing centrifuges in all phlebotomy centers and established a recommendation to unify the system for measuring hemolysis. The indicator External control exceeds acceptance limit clearly highlighted the need to rigorously monitor the analytic phase of the clinical laboratory. The values obtained for the indicator Reports from referred tests exceed delivery time show that there is considerable deviation regarding the expected report delivery time, whereas for in-house laboratory reports, delivery time is satisfactory.
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