The research network of the Spanish Pediatric Emergency Society (RISeuP-SPERG Network) needs to establish its research agenda relevant to pediatric emergency medicine (PEM) to guide the development ...of future projects, as other networks have done before. The aim of our study was to identify priority areas in PEM for a collaborative network of pediatric emergency research in Spain. A multicenter study was developed including pediatric emergency physicians from 54 Spanish emergency departments, endorsed by the RISeuP-SPERG Network. Initially, a group of seven PEM experts was selected among the members of the RISeuP-SPERG. In the first phase, these experts elaborated a list of research topics. Then, using a Delphi method, we sent a questionnaire with that list to all RISeuP-SPERG members, to rank each item using a 7-point Likert scale. Finally, the seven PEM experts, using a modified Hanlon Process of Prioritization, weighted prevalence (A), seriousness of the condition (B), and feasibility of conducting research projects (C) on that condition to prioritize the selected items. Once the list of topics was chosen, the seven experts selected a list of research questions for each of the selected items. The Delphi questionnaire was answered by 74/122 (60.7%) members of RISeuP-SPERG. We established a list of 38 research priorities related to quality improvement (11), infectious diseases (8), psychiatric/social emergencies (5), sedoanalgesia (3), critical care (2), respiratory emergencies (2), trauma (2), neurologic emergencies (1), and miscellanea (4).
Conclusion
: The RISeuP-SPERG prioritization process identified high-priority PEM topics specific to multicenter research that may help guide further collaborative research efforts within the RISeuP-SPERG network to improve PEM care in Spain.
What is Known:
• Some pediatric emergency medicine networks have established their priorities for research.
What is New:
• After a structured process, we have set the research agenda for pediatric emergency medicine in Spain. By identifying high-priority pediatric emergency medicine research topics specific to multicenter research, we may guide further collaborative research efforts within our network.
The resilience of released hatchery-reared specimens increases with age and size, but production costs are also greater for these individuals. Therefore, for a given budget, the consequences of ...increasing age and size impose a trade-off between producing a large number of vulnerable (small) fish or a small number of resilient (large) fish. Once the optimal size for releasing fish has been defined, the choice of rearing protocol will determine the number and quality of the fish that can be released. In this study, different rearing protocols were compared using meagre juveniles (Argyrosomus regius), which are presently the target of a restocking programme conducted in the Balearic Islands (western Mediterranean). Seven different diets were compared during the grow-out phase to identify the diets that produced good-quality juveniles of a given size at the lowest cost. Most of the diets produced juveniles of suitable biological quality in terms of growth, fish condition (relationships between length and total weight, liver weight and mesenteric fat weight) and tissue biochemical composition. A semi-moist diet (Diet G) provided the best growth rate, closely followed by commercial meagre pellets (Diet A). In contrast, the cost of growing fish with Diet A was lower for any possible size at release. This study demonstrates the need to consider both growth rate and production cost to select the rearing protocol that maximizes the number of juveniles that can be produced for a given budget and desired release size. These considerations will ultimately increase the chance of success of restocking programmes.
Cardiovascular (CV) disease is one of the main causes of morbi-mortality in spondyloarthritis (SpA), partially explained by traditional CV risk factors. Information on lipoprotein(a) Lp(a), a ...non-conventional risk factor, in SpA is scarce. In this study we assessed the prevalence of hyperlipoproteinaemia(a) in SpA patients and analysed the possible related factors.
A baseline analysis was made of ankylosing spondylitis (AS) and psoriatic arthritis (PsA) patients and controls included in the CARMA project (CARdiovascular in RheuMAtology), a 10-year prospective study evaluating the risk of CV events in chronic inflammatory rheumatic diseases. A multivariate logistic regression model was performed using hyperlipoproteinaemia(a) (Lp(a) >50 mg/dl) as a dependent variable and adjusting for confounding factors.
19.2% (95% CI: 16.80-22.05) of the SpA patients 20.7% (95% CI: 16.91-24.82) of those with AS and 17.7% (95% CI: 14.15-21.75) of those with PsA and 16.7% (95% CI: 13.23-20.86) of the controls had hyperlipoproteinaemia(a) (p=0.326). Adjusting for age and sex, SpA patients were more likely to have hyperlipoproteinaemia(a) than controls (OR: 1.43, 95%CI: 1.00-2.04; p=0.05), especially those with AS (OR: 1.81, 95%CI: 1.18-2.77; p=0.007). In the adjusted model, apolipoprotein B in all patients, non-steroidal anti-inflammatory drugs in AS, and female sex in PsA, were associated with hyperlipoproteinaemia(a). No disease-specific factors associated with hyperlipoproteinaemia(a) were identified.
SpA patients show a moderately increased risk of hyperlipoproteinaemia(a) compared to controls, especially those with AS. Lp(a) determination may be of interest to improve the CV risk assessment in SpA patients.
The term “Immunonutrition” (IMN) describes the enteral administration of certain substrates with a theoretical immunomodulating function. From all the elements conforming these IMN formulas, Omega-3 ...fatty acids (O3FA) are hypothesized to be the most important component for immunomodulation, with increased anti-inflammatory and antioxidant effect.
A prospective randomized clinical trial of all the patients undergoing laparoscopic Roux-en-Y gastric bypass was performed. Patients were randomly assigned into 2 groups: those patients receiving a preoperative balanced energy high-protein formula (Control Group) and those ones who received the same preoperative nutritional formula enriched with O3FA (Experimental Group). In both groups, there was a restriction to 900 Kcal/day. Nutritional intervention started 10 days before surgery and was maintained up to 8 h before the surgical act. Preoperative weight loss, postoperative pain, complications and acute phase reactants were investigated.
40 patients were included in the study, 20 in each group. Preoperative excess weight loss (EWL) with the prescribed treatment was 10.6 ± 7.7% in Control Group and 14.1 ± 5.8% in the Experimental Group (p = 0.024). Mean postoperative pain was 25 ± 9.2 mm in Control group and 10,9 ± 4,4 mm in Experimental Group (p = 0.015). CRP determined 24 h after surgery was significantly lower in the Experimental Group than in the Control Group. There were not significant differences in complications, mortality or readmission rates between groups.
The use of a nutritional supplement enriched with O3FA is associated with a greater preoperative weight loss, reduced postoperative pain and decreased postoperative levels of C reactive protein.
Abstract Background Although there has been an improved management of invasive candidiasis in the last decade, still controversial issues remain, especially in different therapeutic critical care ...scenarios. Aims We sought to identify the core clinical knowledge and to achieve high agreement recommendations required to care for critically ill adult patients with invasive candidiasis for antifungal treatment in special situations and different scenarios. Methods Second prospective Spanish survey reaching consensus by the DELPHI technique, conducted anonymously by electronic e-mail in the first phase to 23 national multidisciplinary experts in invasive fungal infections from five national scientific societies including intensivists, anesthesiologists, microbiologists, pharmacologists and infectious disease specialists, answering 30 questions prepared by a coordination group after a strict review of literature in the last five years. The educational objectives spanned four categories, including peritoneal candidiasis, immunocompromised patients, special situations, and organ failures. The agreement among panelists in each item should be higher than 75% to be selected. In a second phase, after extracting recommendations from the selected items, a meeting was held with more than 60 specialists in a second round invited to validate the preselected recommendations. Measurements and main results In the first phase, 15 recommendations were preselected (peritoneal candidiasis (3), immunocompromised patients (6), special situations (3), and organ failures (3)). After the second round the following 13 were validated: Peritoneal candidiasis (3) : Source control and early adequate antifungal treatment is mandatory; empirical antifungal treatment is recommended in secondary nosocomial peritonitis with Candida spp. colonization risk factors and in tertiary peritonitis. Immunocompromised patients (5) : consider hepatotoxicity and interactions before starting antifungal treatment with azoles in transplanted patients; treat candidemia in neutropenic adult patients with antifungal drugs at least 14 days after the first blood culture negative and until normalization of neutrophils is achieved. Caspofungin, if needed, is the echinocandin with most scientific evidence to treat candidemia in neutropenic adult patients; caspofungin is also the first choice drug to treat febrile candidemia; in neutropenic patients with candidemia remove catheter. Special situations (2) : in moderate hepatocellular failure, patients with invasive candidiasis use echinocandins (preferably low doses of anidulafungin and caspofungin) and try to avoid azoles; in case of possible interactions review all the drugs involved and preferably use anidulafungin. Organ failures (3) : echinocandins are the safest antifungal drugs; reconsider the use of azoles in patients under renal replacement therapy; all of the echinocandins to treat patients under continuous renal replacement therapy are accepted and do not require dosage adjustment. Conclusions Treatment of invasive candidiasis in ICU patients requires a broad range of knowledge and skills as summarized in our recommendations. These recommendations may help to optimize the therapeutic management of these patients in special situations and different scenarios and improve their outcome based on the DELPHI methodology.
Introduction: The essence of Enhanced Recovery After Surgery (ERAS) programs is the multimodal approach, and many authors have demonstrated safety and feasibility in fast track bariatric surgery. ...According to this concept, a multidisciplinary ERAS program for bariatric surgery has been developed by the Spanish Fast Track Group (ERAS Spain). The aim of this study was to analyze the initial implementation of this Spanish National ERAS protocol in bariatric surgery, comparing it with a historical cohort receiving standard care.
Material and methods: A multi-centric prospective study was performed, including 233 consecutive patients undergoing bariatric surgery during 2015 and following ERAS protocol. It was compared with a historical cohort of 286 patients, who underwent bariatric surgery at the same institutions between 2013 and 2014 and following standard care. Compliance with the protocol, morbidity, mortality, hospital stay and readmission were evaluated.
Results: Bariatric techniques performed were Roux-en-Y gastric bypass and sleeve gastrectomy. There were no significant differences in complications, mortality and readmission. Postoperative pain and hospital stay were significantly lower in the ERAS group. The total compliance to protocol was 80%.
Conclusion: The Spanish National ERAS protocol is a safe issue, obtaining similar results to standard care in terms of complications, reoperations, mortality and readmissions. It is associated with less postoperative pain and earlier hospital discharge.
Introducción Desde 1986 se han realizado cinco estudios de prevalencia de Staphylococcus spp. en España. En este trabajo se presentan los datos de 2006 correspondientes al sexto estudio. Métodos ...Participaron 145 hospitales de todas las areas geográficas y se estudiaron 866 cepas de estafilococos (463 S. aureus ). Se determinó la sensibilidad a 16 antimicrobianos mediante un sistema automatizado de microdilución en caldo. La sensibilidad a tigeciclina se determinó mediante el método de E-test. Resultados La resistencia de S. aureus a oxacilina se ha estabilizado (el 31,2% en 2002 frente al 29,2% en 2006), así como la resistencia a eritromicina, clindamicina y ciprofloxacino. En 2006 los aislados fueron más sensibles a gentamicina (el 16,9% en 2002 frente al 8,6% en 2006; p < 0,001), ninguno presentó sensibilidad disminuida a vancomicina y la resistencia a cotrimoxazol (0,9%) y a rifampicina (0,6%) fue anecdótica. Un aislado fue resistente a linezolid. La resistencia de los estafilococos coagulasa negativos a oxacilina (el 61,3% en 2002 frente al 66,7% en 2006) y a eritromicina (el 63,0% en 2002 frente al 66,5% en 2006) se ha mantenido relativamente estable, aunque ha aumentado la resistencia a gentamicina (el 27,8% en 2002 frente al 44,2% en 2006; p < 0,001), ciprofloxacino (el 44,9% en 2002 frente al 54,3% en 2006; p = 0,010) y clindamicina (el 33,8% en 2002 frente al 46,2% en 2006; p = 0,001). Dos aislados presentaron sensibilidad disminuida a teicoplanina y uno fue resistente a linezolid. Todos los Staphylococcus spp. fueron uniformemente sensibles a quinupristina-dalfopristina y a tigeciclina. Conclusiones En España la resistencia de Staphylococcus spp. a oxacilina sigue siendo elevada, aunque parece haberse estabilizado. Asimismo, comienzan a aparecer aislados resistentes a linezolid.
La troisième parution d’Amerika s’inscrit dans la continuité du numéro antérieur qu’il complète et élargit, dans ses aspects géographiques (Brésil, Colombie, Cuba, Chili), thématiques (droits de ...l’homme, sociétés) et expressifs (arts plastiques, théâtre, cinéma). Elle reprend une sélection de communications du colloque La mémoire et ses représentations esthétiques, tenu à Rennes 2 en février 2010. Cette rencontre a été l’occasion de rendre hommage (en coordination avec Norah Giraldi Dei-Cas et l’Université de Lille 3) au grand intellectuel hispano-uruguayen Fernando Aínsa, qui a prononcé la conférence d’ouverture.
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