Análisis coste-utilidad del modelo de unidad de terapia intravítrea (UTI) frente a la administración tradicional de terapia intravítrea / Cost-utility model of new intravítreous units vs. current patient journey model in Spain

Objetivo Comparar la efectividad y los costes de la implantación del Modelo de Unidad de Terapia Intravítrea (UTI), avalado por la Sociedad Española de Retina y Vítreo (SERV), Sociedad Española de Calidad Asistencial (SECA), Sociedad Española de Oftalmología (SEO) y Sociedad Española de Directivos Sanitarios (SEDISA) vs. el procedimiento habitual. Método Modelo de decisión analítico que compara una organización asistencial tipo UTI con cuatro escenarios de práctica habitual en España, en cuanto al resultado en la calidad de vida por pérdida de agudeza visual y la utilización de recursos. Se estimó la probabilidad, el coste y los años de vida ajustados por calidad (AVAC) para cada escenario planteado. Se realizó un análisis de sensibilidad univariante para cada uno de los parámetros empleados. Resultado Se observó que la implantación del modelo UTI mejora la calidad de vida de los pacientes y presenta un menor coste frente a la práctica habitual. Se produjo ahorro de costes y ganancia de AVAC. El análisis de sensibilidad mostró que el resultado no cambiaría de signo con la modificación de ninguna variable de partida. Conclusiones En las patologías oculares con indicación de tratamiento intravítreo, cualquier reducción en el tiempo que transcurre desde la sospecha diagnóstica hasta la primera inyección intravítrea disminuye la pérdida de agudeza visual. Así, actuar para acortar los tiempos sospecha-aguja es clave para mantener la visión funcional de los pacientes. La mejora de la eficiencia de los servicios de oftalmología que se organizan siguiendo el modelo UTI puede generar ahorros que varían entre los 175 € y 85 € por paciente atendido y año (AU)

Aim To compare the effectiveness and costs of the implementation of the intravitreal therapy unit model, endorsed by the SERV, SECA, SEO and SEDISA, compared to the usual procedure. Method Analytical decision model that compares an UTI-type healthcare organization with four usual practice scenarios in Spain, in terms of quality-of-life results due to loss of visual acuity and the use of resources. The probability, cost, and quality-adjusted life years (QALYs) were estimated for each scenario proposed. A univariate sensitivity analysis was performed for each of the parameters used in the model. Result The model showed that from any of the initial scenarios of the usual practice, transitioning to the UTI-type implementation improves the quality of life of patients and requires lower cost. UTI-type is dominant respect usual practice. The sensitivity analysis showed that the results would not change sign with the variation of any starting variable. Conclusions Shorten suspicion-needle times is key to maintaining functional vision in patients requiring intravitreal treatment. The UTI-type model seeks the efficiency of ophthalmology services and can produce savings that vary between €175 and €85 per patient attended per year (AU)

Cost-utility model of new intravitreous units vs. current patient journey model in Spain.

AIM: To compare the effectiveness and costs of the implementation of the Intravitreal Therapy Unit Model, endorsed by the SERV, SECA, SEO and SEDISA, compared to the usual procedure. METHOD: Analytical decision model that compares an UTI-type healthcare organization with 4 usual practice scenarios in Spain, in terms of quality-of-life results due to loss of visual acuity and the use of resources. The probability, cost, and quality-adjusted life years (QALYs) were estimated for each scenario proposed. A univariate sensitivity analysis was performed for each of the parameters used in the model. RESULT: The model showed that from any of the initial scenarios of the usual practice, transitioning to the UTI-type implementation improves the quality of life of patients and requires lower cost. UTI-type is dominant respect usual practice. The sensitivity analysis showed that the results would not change sign with the variation of any starting variable. CONCLUSIONS: Shorten suspicion-needle times is key to maintaining functional vision in patients requiring intravitreal treatment. The UTI-type model seeks the efficiency of ophthalmology services and can produce savings that vary between Є175 and Є85 per patient attended per year.

Análisis de minimización de costes de brolucizumab en el tratamiento de la degeneración macular asociada a la edad neovascular / Cost minimization analysis of brolucizumab in the treatment of neovascular age-related macular degeneration

Introducción Brolucizumab es un nuevo fármaco antifactor de crecimiento endotelial vascular (anti-VEGF) administrado con una pauta fija de ocho o 12 semanas que en los estudios HAWK y HARRIER demostró ser no inferior a aflibercept con respecto a la mejor agudeza visual corregida, bajo una menor carga de administración. El objetivo del análisis fue comparar los costes directos sanitarios de ambos anti-VEGF como tratamiento en pacientes con degeneración macular asociada a la edad neovascular. Material y métodos Se realizó un análisis de minimización de costes bajo un horizonte temporal de 25 años y considerando el coste farmacológico, de administración, de pruebas de seguimiento y del manejo de eventos adversos. El uso de recursos fue obtenido de literatura relacionada y validada por expertos clínicos. Se llevaron a cabo diversos análisis de escenarios para comprobar la robustez de los resultados. Resultados Brolucizumab resultó con un menor coste por paciente en comparación con aflibercept, considerando el número de inyecciones derivadas de los estudios HAWK y HARRIER. Este resultado se mantuvo en los diferentes escenarios analizados, excepto frente al número de inyecciones de la pauta flexible de aflibercept del estudio ARIES, ya que la menor discontinuación de tratamiento con brolucizumab conlleva mantener el tratamiento de más pacientes. Al considerar la misma discontinuación, brolucizumab mantuvo los resultados observados en el caso base del análisis. Conclusiones El presente estudio muestra como la pauta de administración fija de brolucizumab puede ayudar a disminuir la carga asistencial para los centros sanitarios y los pacientes (AU)

Introduction Brolucizumab is a novel anti-vascular endothelial growth factor (anti-VEGF) drug administered in a fixed regimen of 8 or 12 weeks which, in the HAWK and HARRIER studies, was shown not to be inferior to aflibercept with respect to the best corrected visual acuity, with a less burdensome treatment regimen. The aim of the analysis was to compare the direct healthcare costs of both anti-VEGF as a treatment in patients with neovascular age-related macular degeneration.Material and methods A cost minimization analysis was performed under a 25-year time horizon and considering the drug costs, administration, follow-up tests, and management of adverse events. Resource use was obtained from the related literature and validated by clinical experts. Various scenario analysis were carried out to check the robustness of the results. Results Brolucizumab resulted in a lower cost per patient compared with aflibercept, considering the number of injections derived from the HAWK and HARRIER studies. This result was maintained in the different scenarios analysed, except for the number of injections of the flexible aflibercept regimen of the ARIES study, since the lower discontinuation of treatment with brolucizumab implies maintaining the treatment of more patients. Considering the same discontinuation, brolucizumab maintained the results observed in the base case of the analysis. Conclusions This study shows how the fixed administration regimen of brolucizumab can help reduce both healthcare and patients’ burden (AU)

Cost minimization analysis of brolucizumab in the treatment of neovascular age-related macular degeneration.

INTRODUCTION: Brolucizumab is a novel anti-vascular endothelial growth factor (anti-VEGF) drug administered in a fixed regimen of 8 or 12 weeks which, in the HAWK and HARRIER studies, was shown not to be inferior to aflibercept with respect to the best corrected visual acuity, with a less burdensome treatment regimen. The aim of the analysis was to compare the direct healthcare costs of both anti-VEGF as a treatment in patients with neovascular age-related macular degeneration. MATERIAL AND METHODS: A cost minimization analysis was performed under a 25-year time horizon and considering the drug costs, administration, follow-up tests, and management of adverse events. Resource use was obtained from the related literature and validated by clinical experts. Various scenario analysis were carried out to check the robustness of the results. RESULTS: Brolucizumab resulted in a lower cost per patient compared with aflibercept, considering the number of injections derived from the HAWK and HARRIER studies. This result was maintained in the different scenarios analysed, except for the number of injections of the flexible aflibercept regimen of the ARIES study, since the lower discontinuation of treatment with brolucizumab implies maintaining the treatment of more patients. Considering the same discontinuation, brolucizumab maintained the results observed in the base case of the analysis. CONCLUSIONS: This study shows how the fixed administration regimen of brolucizumab can help reduce both healthcare and patients' burden.

Effectiveness of cell culture-based influenza vaccines compared with egg-based vaccines: What does the literature say?

OBJECTIVE: Influenza vaccination is an effective way of reducing the burden of seasonal influenza. Chicken egg embryos are the most common source of influenza vaccines, but cell culture production has emerged as an alternative that could be advantageous. This article reviews the available literature on the efficacy/effectiveness of cell culture-based influenza vaccines compared with egg-based vaccines. METHODS: We conducted a review of the actual literature and analyzed those studies comparing the effectiveness of cell culture-based and egg-based vaccines in the last ten years. RESULTS: Eight studies were analyzed; 1 was a clinical trial and 7 were retrospective cohort studies. The clinical trial found no significant differences in the efficacy of both vaccines with respect to placebo. The results of the observational studies were inconsistent and relative effectiveness varied among studies, even though most were performed during the same season, and in some cases, in the same region and using the same data records. Furthermore, in most studies, the comparisons between vaccines were not statistically significant. CONCLUSIONS: There is insufficient evidence that cell culture-based vaccines are superior to egg-based vaccines in terms of efficacy/effectiveness.

Silver and gold nanoparticles in nanometric confined templates: synthesis and alloying within the anisotropic pores of oblique angle deposited films.

In this work we have developed an infiltration methodology to incorporate metal nanoparticles (NPs) of controlled size and shape into the open voids available in oblique angle deposited thin films. These NPs exhibited well-defined surface plasmon resonances (SPRs). The nanometric confined space provided by their porous microstructure has been used as a template for the growth of anisotropic NPs with interesting SPR properties. The fabrication methodology has been applied for the preparation of films with embedded Ag and Au NPs with two associated plasmon resonance features that developed a dichroic behaviour when examined with linearly polarized light. A confined alloying process was induced by near IR nanosecond laser irradiation yielding bimetallic NPs with SPR features covering a large zone of the electromagnetic spectrum. The possibilities of the method for the tailored fabrication of a wide range colour palette based on SPR features are highlighted.

Incidence, recurrence and cost of hyperglycaemic crises requiring emergency treatment in Andalusia, Spain.

AIMS: Hyperglycaemic crises (diabetic ketoacidosis and hyperosmolar hyperglycaemic state) are medical emergencies in people with diabetes. We aimed to determine their incidence, recurrence and economic impact. METHODS: An observational study of hyperglycaemic crises cases using the database maintained by the out-of-hospital emergency service, the Healthcare Emergency Public Service (EPES) during 2012. The EPES provides emergency medical services to the total population of Andalusia, Spain (8.5 million inhabitants) and records data on the incidence, resource utilization and cost of out-of-hospital medical care. Direct costs were estimated using public prices for health services updated to 2012. RESULTS: Among 1 137 738 emergency calls requesting medical assistance, 3157 were diagnosed with hyperglycaemic crises by an emergency coordinator, representing 2.9 cases per 1000 persons with diabetes [95% confidence intervals (CI) 2.8 to 3.0]. The incidence of diabetic ketoacidosis was 2.5 cases per 1000 persons with diabetes (95% CI 2.4 to 2.6) and the incidence of hyperosmolar hyperglycaemic state was 0.4 cases per 1000 persons with diabetes (95% CI 0.4 to 0.5). In total, 17.7% (n = 440) of people had one or more hyperglycaemic crisis. The estimated total direct cost was €4 662 151, with a mean direct cost per episode of €1476.8 ± 217.8. CONCLUSIONS: Hyperglycaemic crises require high resource utilization of emergency medical services and have a significant economic impact on the health system.

Influenza vaccination during the first 6 months after solid organ transplantation is efficacious and safe.

Preventing influenza infection early after transplantation is essential, given the disease's high mortality. A multicentre prospective cohort study in adult solid organ transplant recipients (SOTR) receiving the influenza vaccine during four consecutive influenza seasons (2009-2013) was performed to assess the immunogenicity and safety of influenza vaccination in SOTR before and 6 months after transplantation. A total of 798 SOTR, 130 of them vaccinated within 6 months of transplantation and 668 of them vaccinated more than 6 months since transplantation. Seroprotection was similar in both groups: 73.1% vs. 76.5% for A/(H1N1)pdm (p 0.49), 67.5% vs. 74.1% for A/H3N2 (p 0.17) and 84.2% vs. 85.2% for influenza B (p 0.80), respectively. Geometric mean titres after vaccination did not differ among groups: 117.32 (95% confidence interval (CI) 81.52, 168.83) vs. 87.43 (95% CI 72.87, 104.91) for A/(H1N1)pdm, 120.45 (95% CI 82.17, 176.57) vs. 97.86 (95% CI 81.34, 117.44) for A/H3N2 and 143.32 (95% CI 103.46, 198.53) vs. 145.54 (95% CI 122.35, 174.24) for influenza B, respectively. After adjusting for confounding factors, time since transplantation was not associated with response to vaccination. No cases of rejection or severe adverse events were detected in patients vaccinated within the first 6 months after transplantation. In conclusion, influenza vaccination within the first 6 months after transplantation is as safe and immunogenic as vaccination thereafter. Thus, administration of the influenza vaccine can be recommended as soon as 1 month after transplantation.

Diffraction by three-dimensional slit-shape curves: decomposition in terms of Airy and Pearcey functions.

We analyze the diffraction field generated by coherent illumination of a three-dimensional transmittance characterized by a slit-shape curve. Generic features are obtained using the Frenet-Serret equations, which allow a decomposition of the optical field. The analysis is performed by describing the influence of the curvature and torsion on osculating, normal, and rectifying planes. We show that the diffracted field has a decomposition in three optical fields propagating along three optical axes that are mutually perpendicular. The decomposition is in terms of the Pearcey and Airy functions, and the generalized Airy function. Experimental results are shown.

Predation potential of Chilocorus cacti (Coleoptera: Coccinellidae) to the prickly pear cacti pest Dactylopius opuntiae (Hemiptera: Dactylopiidae).

Functional response of the predator Chilocorus cacti (Linnaeus) (Coleoptera: Coccinellidae) on five densities of Dactylopius opuntiae (Cockerell) (Hemiptera: Dactylopiidae) female adults was assessed under laboratory conditions. The searching efficiency of C. cacti significantly decreased as prey density increased. The logistic regression for the predator had a negative and significant linear parameter indicating a type II functional response. Non-linear regression for Holling predator equation estimated a handling time of 1.79 ± 0.129 h and attack rate coefficient of 0.1003 ± 0.030. Most of this handling time was because the predator spent a lot of time removing the waxy coating that protects adult females of D. opuntiae. Chilocorus cacti consumes females of D. opuntiae in their reproductive stage; therefore, it could be an effective natural enemy to suppress or regulate low density populations of D. opuntiae, preventing them to reach high densities.

[Back pain and restricted daily physical activity in the Spanish adult population]. / Dolor de espalda y limitación de la actividad física cotidiana en la población adulta española.

BACKGROUND: Low back pain is a widespread health problem that affects a great part of the Spanish adult population; it also places a constraint on developing activities of daily living. The aim of this paper is to estimate the association between daily physical activity and chronic back pain in Spain. MATERIAL AND METHODS: This paper analyses data from the European Health Survey in Spain 2009; it presents a cross sectional epidemiological study designed to assess the health of the Spanish population, in which 22,188 people participated (10,876 men and 11,312 women over 16 years ), representative of the total Spanish population. The variables studied are: back pain indicators obtained from the European Health Status Module and the European Health Care Module included in this survey, and the daily physical activity pattern obtained from the European Module of Health Determinants. RESULTS: The total volume of daily physical activity is similar in healthy people and those who have back pain, but a pattern of low or moderate intensity in people with chronic back pain in the last twelve months (p <0.01) was observed with greater frequency. CONCLUSIONS: People with chronic back pain do not show a lower volume of physical activity, but their physical activity pattern is often low or moderate. Developing a vigorous pattern of physical activity should be considered not only as a strategy to prevent this disease, but also as a therapeutic target in these patients.

Tarjeta de Triage TASSICA 2: evaluación práctica de su funcionalidad operativa en incidentes con múltiples víctimas / No disponible

La tarjeta TASSICA 2 es una tarjeta de triage profesional dirigida a los servicios sanitarios para la intervención en incidentes con múltiples victimas (IMV). El desarrollo de la tarjeta TASSICA 2 se inicia en 2008, en el seno de un equipo de trabajo de uno de los servicios profesionales de emergencias de mayor envergadura, el SUMMA 112 de Madrid. Se plantea como instrumento que facilite la labor de los equipos de emergencias en el desempeño de sus funciones en la atención a IMV, favoreciendo al mismo tiempo la normalización de procedimientos asistenciales y contribuyendo al mantenimiento de los estándares de calidad. El objeto de este trabajo es verificar, en condiciones de simulación próximas a la intervención real en IMV, la utilidad de la tarjeta TASSICA 2 y el cumplimiento efectivo de los objetivos para los cuales fue diseñada(AU)

TASSICA 2 card is a professional triage card addressed to health services for intervention in incidents with multiple victims (IMV). The development of the card TASSICA 2 starts in 2008, within a team of one of the professional services of larger emergencies, Madrid SUMMA 112. Arises as a tool to facilitate the work of emergency teams in performing their duties in caring for IMV, while promoting the standardization of care and contributing to the maintenance of quality standards. The purpose of this paper is to verify in simulation conditions close to real action in IMV, utility TASSICA card 2 and the effective implementation of the objectives for which it was designed(AU)

Guía de práctica clínica de consenso de la Sociedad Andaluza de Epilepsia: recomendaciones terapéuticas ante una crisis epiléptica y en el estado epiléptico / Consensus clinical practice guidelines of the andalusian epilepsy society: Therapeutic recommendations when dealing with a first epileptic seizure and in epileptic status

Introducción. La gran mayoría de crisis epilépticas son breves y autolimitadas, pero, en ocasiones, su duración puede ser mayor de la esperada, lo que, en el caso de las crisis convulsivas generalizadas, comporta un alto riesgo de morbimortalidad, que aumenta con su duración. Esta gravedad justifica la realización de una guía de práctica clínica de consenso, basada en evidencias implícitas sobre aspectos relacionados con el manejo terapéutico recomendado a un paciente con una crisis prolongada asistido en los servicios de urgencias. Materiales y métodos. Se ha realizado una búsqueda selectiva de la información científica relacionada con el tema propuesto en Pubmed-Medline, utilizando filtros de evidencia científica. Dicha búsqueda se completó en otros buscadores de evidencia científica, como Tripdatabase, Biblioteca Cochrane Plus o DARE. Las referencias seleccionadas se analizaron y discutieron por los autores y se extrajeron las evidencias disponibles y las recomendaciones de ellas derivadas. Resultados. Se identificaron 33 documentos primarios y seis guías de práctica o protocolos relacionados con el tema propuesto. Las recomendaciones se insertaron en el texto de manera explícita. Conclusiones. El protocolo terapéutico debe iniciarse ante cualquier crisis convulsiva con una duración superior a cinco minutos, asegurando, en primer lugar, la correcta función respiratoria y cardiocirculatoria, y administrando fármacos antiepilépticos por vía intravenosa de acción rápida y con dosis altas, mantenidos hasta que se identifica y controla la causa. Las crisis no convulsivas prolongadas, por su menor morbimortalidad, no precisan generalmente de una terapia tan enérgica y con riesgo de complicaciones (AU)

Introduction. Most epileptic seizures are brief and self-limiting, but sometimes they can last longer than expected and this entails (in the case of generalised seizures) a high risk of morbidity and mortality, which increases as they get longer. This severity justifies the need to draw up a set of consensus-based practice guidelines based on implicit evidence, to use Liberati’s nomenclature, concerning aspects related to the recommended therapeutic management of a patient with prolonged seizures who is being attended in an emergency department. Materials and methods. A selective search was conducted on PubMed-Medline for scientific information related to the subject using scientific evidence filters. This search was completed in other scientific evidence search engines, such as Tripdatabase, Biblioteca Cochrane Plus or DARE. The selected references were analysed and discussed by the authors, and the available evidence and any recommendations that could be drawn from it were collected. Results. The search revealed the existence of 33 primary documents and six practice guidelines or protocols related with the topic under study. The recommendations were inserted in the text explicitly. Conclusions. The therapeutic protocol must be started when faced with any seizures that last more than five minutes. First, steps must be taken to ensure proper respiratory and cardiocirculatory functioning, and then fast-acting antiepileptic drugs are administered intravenously and in high doses until the cause is identified and controlled. Due to their lower level of morbidity and mortality, prolonged non-convulsive seizures do not generally require therapy that is so vigorous and with such a high risk of complications (AU)

[Consensus clinical practice guidelines of the Andalusian Epilepsy Society: therapeutic recommendations when dealing with a first epileptic seizure and in epileptic status]. / Guia de practica clinica de consenso de la Sociedad Andaluza de Epilepsia: recomendaciones terapeuticas ante una crisis epileptica y en el estado epileptico.

INTRODUCTION: Most epileptic seizures are brief and self-limiting, but sometimes they can last longer than expected and this entails (in the case of generalised seizures) a high risk of morbidity and mortality, which increases as they get longer. This severity justifies the need to draw up a set of consensus-based practice guidelines based on implicit evidence, to use Liberati's nomenclature, concerning aspects related to the recommended therapeutic management of a patient with prolonged seizures who is being attended in an emergency department. MATERIALS AND METHODS: A selective search was conducted on PubMed-Medline for scientific information related to the subject using scientific evidence filters. This search was completed in other scientific evidence search engines, such as Tripdatabase, Biblioteca Cochrane Plus or DARE. The selected references were analysed and discussed by the authors, and the available evidence and any recommendations that could be drawn from it were collected. RESULTS: The search revealed the existence of 33 primary documents and six practice guidelines or protocols related with the topic under study. The recommendations were inserted in the text explicitly. CONCLUSIONS: The therapeutic protocol must be started when faced with any seizures that last more than five minutes. First, steps must be taken to ensure proper respiratory and cardiocirculatory functioning, and then fast-acting antiepileptic drugs are administered intravenously and in high doses until the cause is identified and controlled. Due to their lower level of morbidity and mortality, prolonged non-convulsive seizures do not generally require therapy that is so vigorous and with such a high risk of complications.

[Consensus clinical practice guidelines of the Sociedad Andaluza de Epilepsia for the diagnosis and treatment of patients with their first epileptic seizure in emergencies]. / Guía de práctica clínica de consenso de la Sociedad Andaluza de Epilepsia para el diagnóstico y tratamiento del paciente con una primera crisis epiléptica en situaciones de urgencia.

INTRODUCTION AND AIMS: Epileptic seizures are the cause of between 0.3 and 1.2% of all visits to hospital emergency departments. Twenty-five per cent of patients visit after having their first seizure. Such an impact seems to justify the development of a health care protocol. Our proposal is to draw up a set of implicit evidence-based consensus practice guidelines, to use Liberati's nomenclature, concerning aspects related to the diagnostic procedure and recommended therapeutic management of patients with a first seizure who are being attended in an emergency department. MATERIALS AND METHODS: A selective search was conducted on PubMed-Medline for quality scientific information on the subject using scientific evidence filters. This search was completed in other scientific evidence search engines, such as Tripdatabase, Biblioteca Cochrane Plus or DARE. The selected references were analysed and discussed by the authors, and the available evidence and any recommendations that could be drawn from it were collected. RESULTS: A total of 47 primary documents and 10 practice guidelines or protocols related with the proposed topic were identified. The recommendations were inserted in the text explicitly. CONCLUSIONS: The diagnostic and therapeutic protocol for all paroxysmal phenomena in emergencies consists of three successive phases: diagnosis of the cause of the epilepsy, integration of the significance of the seizure within the clinical context, and designing the therapeutic scheme. Each phase will depend on the outcomes of the previous one as a decision algorithm. The fundamental tools in each phase are: patient record and examination (phase 1), and complementary tests (phase 2). They are then used to produce a therapeutic decision scheme.

[Hyperammonaemic encephalopathy due to valproic acid]. / Encefalopatía hiperamoniémica por ácido valproico.

INTRODUCTION: One of the less frequent idiosyncratic side effects of valproic acid (VPA) is encephalopathy. Here we report one case. CASE REPORT: An 83-year-old female with no relevant past history, who received treatment with VPA following a post-traumatic subarachnoid haemorrhage and two convulsive seizures. A few days later, she was admitted to the Emergency Department because of a progressive clinical picture of mental slowness, nauseas and apathy. The systemic examination was normal. Neurologically, the most striking features were inattention and disorientation, despite her having a good level of consciousness, and mental confusion. Levels of VPA were within the below-therapeutic range and the basic lab findings (including hepatic profile) were normal, except for hyperammonaemia. Neuroimaging studies and cerebrospinal fluid analysis were also normal. An electroencephalogram (EEG) showed signs of severe diffuse encephalopathy with slow, triphasic waves and a non-convulsive epileptic status was therefore ruled out. After withdrawing the VPA, the patient's condition improved until her basal situation was reached in 48 hours and the EEG became normal, as did her ammonium levels. CONCLUSION: When faced with a patient who has recently been taking VPA and who presents a clinical picture of mental confusion, the possibility of encephalopathy due to said drug must be taken into consideration.

Encefalopatía hiperamoniémica por ácido valproicomage / Hyperammonaemic encephalopathy due to valproic acid

Uno de los efectos adversos idiosincrásicos menos frecuentes del ácido valproico (VPA) es la encefalopatía.Presentamos un caso. Caso clínico. Mujer de 83 años sin antecedentes de interés, que tras sufrir una hemorragiasubaracnoidea postraumática y dos crisis epilépticas, recibe tratamiento con VPA. Pocos días después ingresa en Urgencias por cuadro progresivo de torpeza mental, náuseas y apatía. La exploración sistémica era normal. Neurológicamente destacaba la inatención y la desorientación a pesar de un buen nivel de conciencia y la confusión mental. Los niveles de VPA estabanen rango infraterapéutico y la analítica básica (incluido el perfil hepático) era normal, salvo por una hiperamoniemia. También eran normales los estudios de neuroimagen y el análisis del líquido cefalorraquídeo. Un electroencefalograma (EEG) reveló signos de encefalopatía difusa grave con ondas trifásicas y ondas lentas, por lo que se descartó un estado epiléptico noconvulsivo. Tras retirar el VPA, la paciente mejoró hasta su situación basal en 48 horas, y el EEG se normalizó, al igual que los niveles de amonio. Conclusión. Ante cualquier paciente al que se le haya instaurado VPA recientemente, y que presente uncuadro de confusión mental, es preciso considerar una encefalopatía por dicho fármaco

One of the less frequent idiosyncratic side effects of valproic acid (VPA) is encephalopathy. Here wereport one case. Case report. An 83-year-old female with no relevant past history, who received treatment with VPA following a post-traumatic subarachnoid haemorrhage and two convulsive seizures. A few days later, she was admitted to the Emergency Department because of a progressive clinical picture of mental slowness, nauseas and apathy. The systemic examination wasnormal. Neurologically, the most striking features were inattention and disorientation, despite her having a good level of consciousness, and mental confusion. Levels of VPA were within the below-therapeutic range and the basic lab findings (including hepatic profile) were normal, except for hyperammonaemia. Neuroimaging studies and cerebrospinal fluid analysiswere also normal. An electroencephalogram (EEG) showed signs of severe diffuse encephalopathy with slow, triphasic waves and a non-convulsive epileptic status was therefore ruled out. After withdrawing the VPA, the patient’s condition improved untilher basal situation was reached in 48 hours and the EEG became normal, as did her ammonium levels. Conclusion. When faced with a patient who has recently been taking VPA and who presents a clinical picture of mental confusion, the possibility of encephalopathy due to said drug must be taken into consideration

Ceguera cortical transitoria tras la administración de contrastes angiográficos / Transient cortical blindness following the administration of angiographic contrasts

No disponible

[The patient's right to information: influence of socio-professional factors in primary care]. / Derecho de información de los pacientes: influencia de las características socioprofesionales en atención primaria.

OBJECTIVES: To describe the information provided by primary care doctors to their patients in different phases of the care provision process and to analyse any relationships with socio-professional factors. DESIGN: Descriptive, cross-sectional study based on postal questionnaire. SETTING: Primary care centres in Murcia, Spain. PARTICIPANTS: 227 family physicians. INTERVENTIONS: Distribution of a questionnaire which includes: a) socio-professional variables (age, sex, marital status, years in practice, years in present post, work environment, previous training, number of patients on list, number of patients seen daily); b) an evaluation of job satisfaction (Likert scale) related to salary, career choice, immediate superiors and daily surgery; and c) the frequency with which information is provided to patients concerning diagnosis, prognosis, treatment, complementary examinations and personal, professional and family impact. MAIN MEASUREMENTS AND RESULTS: The reply rate was 59%. The percentages of doctors who always provided information concerning diagnosis, prognosis, treatment, complementary examinations and person, professional and family impact was, 23.3%, 7%, 64.3%, 40.5%, and 9.7%, respectively. There was a direct and statistically significant relationship between job satisfaction and the information provided to patients, the doctors feeling most satisfaction providing the most information on the different phases of the care process. On the other hand, there was an inverse and statistically significant relationship between the number of patients on the doctors' lists and the information provided. CONCLUSIONS: The degree of fulfillment of the patient's right to information is low. Doctors should realise the practical importance of clinical information in their work. There is a general feeling of discontent amongst family doctors, which has a negative impact on their professional activity. A lighter workload would significantly improve the extent to which doctors provide patients with information and mechanisms should be put in place to improve working conditions to avoid the non-fulfillment of the patient's right to information.