Implementation of the use of SPECT-portable for evaluation of surgical margins in breast cancer with indication of ROLL: First results.

OBJECTIVES: Main objective: To compare the effectiveness for checking surgical margins between SPECT-portable and mammography of the piece (RxM). SECONDARY OBJECTIVE: To standardize a pre-operative protocol using SPECT-portable and to evaluate the time required in the use of this technique. MATERIAL AND METHODS: Prospective longitudinal study with 36 patients (39 lesions) diagnosed with breast cancer (CM) with criteria for SNOLL/ROLL. A pre-surgical study of the tumor lesion was performed, after the eco-guided administration of 99mTc-nanocolloids of albumin/99mTc-macroaggregates of albumin, in the tumor lesion. Hybrid images (optical + SPECT) and 3D navigation images with gamma probe are obtained using freehandSPECT. In the operating room, 4-5 images are obtained with freehandSPECT, (I) on skin for tumor location, (II) after exposure of surgical bed for resection guide, (III) of the surgical bed after exeresis, (IV and V) the anterior-posterior and lateral surface of the surgical specimen. The three criteria to decide to extend the margins are: (a) residual activity (cps) at the edges of the surgical bed resection; (b) visual analysis of the uptake in the specimen; (c) a minimum distance of 10 mm from the edges of the specimen to the center of greatest uptake, plus the radius of the lesion. We study the concordance of: the depth measurement between ultrasound and freehandSPECT; the surgical margins between freehandSPECT vs. mammography of the specimen (RxM), considering anatomical pathology (AP) as the gold standard technique as reference; surgical time used with freehandSPECT and RxM. RESULTS: Intraoperative localization was performed in all cases. False negative (FN: no detection margin affected) with freehandSPECT: 9 margins; with RxM: 8. True positive (TP: detection margin affected) with freehandSPECT: 5 margins, with RxM: 6. True negative (TN: consider free margin when healthy) with freehandSPECT: 213 margins; with RxM: 196. Negative predictive value (NPV: probability of negative margin on unaffected part) with freehandSPECT: 95.9%, with RxM: 96.07%. Specificity with freehandSPECT: 96.8%, with RxM: 97%. The concordance of surgical bed margins between freehandSPECT and RxM: 94.5%. Between freehandSPECT and AP: 93.1%. Between RxM and PA: 93.5%, being all statistically significant (p-value <0.000), so we can affirm that both techniques are related or dependent on the reference technique, the PA. Degree of correlation between SPECT-portable and low PA (Kappa index: 0.34, 95% CI [0.22-0.47], and between RxM and moderate PA (Kappa index: 0.42, 95% CI [0.29-0.56], p-value <0.001. Comparison of the successes and failures of both techniques (SPECT-portable and RxM) and PA: Distribution χ2: 0.023 with degree of freedom 1, with value <0.05, so we can affirm that both techniques are similar, since there are no significant statistical differences. Median total OR time: 60.25 min (30-145). Mean freehandSPECT OR time: 5 scans = 10 min. CONCLUSIONS: There are no statistically significant differences in the probability to rule out affective margins that require a second surgery between both techniques (SPECT-portable and RxM) so, the technique performed with SPECT-Portable is a useful and effective procedure, which requires specific training with an optimized and multidisciplinary protocol. The time spent with SPECT-portable is feasible for daily practice.

Does Skilled Nursing Facility Trigger Tool used with Global Trigger Tool increase its value for adverse events evaluation?

OBJECTIVE: To assess the additional value in the evaluation of incidents and adverse events by adding the IHI Skilled Nursing Facility Trigger Tool (SNFTT) to the Institute for Healthcare Improvement's Global Trigger Tool (GTT) in an acute geriatric hospital. MATERIAL AND METHODS: A one-year retrospective study reviewing 240 electronic clinical records using the general GTT, either alone or combined with SNFTT. MAIN OUTCOME MEASURES: Number of triggers and identified adverse events (AEs), categories of severity and preventability of AEs, GTT incidence rates, and the number needed to alert (NNA). RESULTS: One hundred and thirty-seven AEs were identified in 107 patients (57.1 AEs per 100 admissions). Of these, 127 (92.7%) occurred 3 or more days after admissions; 49.6% of the harm events were preventable. The NNA for GTT plus SNFTT was 8.6. No significant difference was found using the general GTT alone versus the general GTT plus SNFTT in terms of the main outcome measures. Eleven categories of triggers were better identified when using GTT plus SNFTT because with GTT alone they were allocated to a category of "Other": 9 from the care module (C15) and 2 from the medication module (M13). CONCLUSIONS: The study demonstrates that adding the SNFTT to the GTT did not increase its effectiveness as regards the evaluation of AEs. However, some triggers are better described in SNFTT and now have now been added into the general GTT method in our hospital.

Daily consumption of milk enriched with fish oil, oleic acid, minerals and vitamins reduces cell adhesion molecules in healthy children.

BACKGROUND AND AIMS: Several studies have suggested that polyunsaturated fatty acids, vitamins and minerals have beneficial effects on lipid profile and systemic inflammation in adults. METHODS AND RESULTS: We examined the effects of a daily intake of milk enriched with longchain polyunsaturated fatty acids, oleic acid, carbohydrates, vitamins, minerals and low in saturated fatty acids (SFAs) for 5 months, on several cardiovascular (CVD) risk biomarkers in healthy children aged 8-14 years. In a randomized double-blind placebo-controlled trial, a total of 107 children of both genders were assigned to two study groups: 1) a supplemented group (SG, n=53) who consumed 0.6 L/day of an enriched dairy product, and 2) a control group (CG, n=54) who consumed 0.6 L/day of standard whole milk. Both groups consumed the dairy drinks for 5 months, in addition to their usual diet. Serum levels of adhesion molecules as indices of vascular endothelial cell activation were assessed in both groups at 0 and 5 months as well as white blood cell counts, lipid profile, serum proteins, total serum calcium, 25-OH vitamin D, glucose, insulin and adiponectin. In the enriched dairy drink supplemented group, adhesion molecules E-selectin and ICAM-1 as well as lymphocyte levels decreased while plasma docosahexaenoic acid (DHA) and serum calcium concentrations increased. In the control group, serum total protein, transferrin, total cholesterol, HDL-cholesterol and adiponectin concentrations decreased. CONCLUSION: The consumption of a milk enriched with fish oil, oleic acid, minerals and vitamins reduced indices of endothelial cell activation in the studied group of healthy children.

Gallic acid and tannase accumulation during fungal solid state culture of a tannin-rich desert plant (Larrea tridentata Cov.).

Larrea tridentata (Sesse & Mocino ex DC.) Coville, also known as Larrea, gobernadora, chaparral, or creosote bush, is a shrubby plant which dominates some areas of the desert southwest in the United States and Northern Mexico and its use has not been exploited and standardized. In this study, gobernadora was studied to evaluate its potential use for support of solid state culture. Influence of two minimal media added with gobernadora powder as the sole carbon source and inducer of tannin-degrading enzymes was evaluated. Cultures were initially 70% moisture, had a pH of 5.5 and were inoculated with Aspergillus niger Aa-20 at 2 x 10(7) spores per gram of media. Analysis of pH, moisture, tannin uptake, gallic acid accumulation and tannase production were evaluated. Results indicated a high content of condensed (39.4%dm) and hydrolysable (22.8%dm) tannins. Invasion capacity of fungal growth was of 0.15 mmh(-1). Tannase production reached values of 1040 Ul(-1) at 43 h of culture. During the first 48 h of culture, the concentration of gallic acid accumulation was 0.33 gl(-1). Gobernadora is a potential source of gallic acid and tannase production by solid state culture; however, further optimization of the process is needed.

Las lesiones deportivas atendidas en el área de urgencias / Sports lesions attended at the emergency area

Objetivo: Conocer la prevalencia de las lesiones deportivas en urgencias, determinar la lesión más frecuente, qué deportes generan lesiones y cómo se distribuyen éstas según sexo, edad, mecanismo lesional y abordaje terapéutico desde urgencias. Métodos: Estudio prospectivo, de febrero a julio de 2003, dirigido a la población general atendida en urgencias con lesiones deportivas. Variables estudiadas: edad, sexo, mes de atención, deporte practicado, zona del cuerpo lesionada, mecanismo lesional, estudios complementarios, diagnóstico, tratamiento y destino del paciente. Los resultados son expresados como media y desviación estándar, número y frecuencia, comparación de variables con χ2 considerando significativo p<0,05.Los datos fueron analizados con el programa SPSS 11.0.Resultados: 134 urgencias por lesiones deportivas, con mayor frecuencia en febrero (22,81%), marzo (25,3%), abril (11,27%); 68% varones; edad media 20 años σ= 10,44, 51% menores de 18 años. Los deportes más frecuentes fueron fútbol (37,3%) y esquí (16,4%); 94% consultaron por una lesión; 45,5% miembros inferiores y 36,6% superiores. El mecanismo lesional más frecuente fue traumatismo directo (41%).El diagnóstico más frecuente fue esguince (45,5%). El 41,8% fueron lesiones leves. La prueba más solicitada fue radiografía (94,7%) y el tratamiento más utilizado inmovilización con analgesia/antiinflamatorios. El 91% fueron dados de alta y el 40,3% precisó seguimiento en consulta. Conclusiones: El deportista tipo atendido es varón, de 20 años, que practica fútbol, lesionado en miembros inferiores con esguince de tobillo de pronóstico leve, por torsión externa y traumatismo directo al que se le prescribe inmovilización y tratamiento médico desde urgencias. El servicio de urgencias es eficaz y resolutivo en el diagnóstico y tratamiento de lesiones deportivas. Los deportes generan lesiones atendidas en los servicios de urgencias, por lo que debemos estar familiarizados con ellas (AU)

Aim: To assess the prevalence of sports lesions in the emergency setting and to establish which are the most frequent ones, which sports cause lesions and how are they distributed according to gender, age, lesional mechanism and emergency therapeutic approach. Methods: Prospective study carried out from February to July 2003 on the general population seen at emergency outpatient clinics because of sports lesions. Variables considered: age, gender, month in which seen, sport involved, affected body region, lesional mechanism, complementary studies performed, diagnosis, management and final fate of the patient. The results are expressed as means and standard deviations with number and frequency, and variable comparison with the χ2 test (p<0.05 was considered significant). The SPSS 11.0 software package was used for the analyses. Results: A total of 134 emergency cases due to sports lesions were seen; such lesions were more frequent in February (22.81%), March (25.3%)and April (11.27%). Sixty-eight per cent of the patients were males, and the mean age was 20 ± 0.44 years; 51% of the patients were aged less than 18 years. The most frequently involved sports were soccer (37.3%)and skiing (16.4%); 94% consulted because of a lesion, affecting the lower limbs in 45.5% of the cases and the upper limbs in 36.6%. The most frequent lesional mechanism was direct trauma (41%); the diagnosis most often established was that of sprain (45.5%), and most lesions (41.8%)were mild. The most often requested complementary test was radiography(94.7%). The therapy most often used was immobilisation with analgesics/antiinflammatories. Ninety-one per cent of the patients were discharged, and 40.3% required follow-up in the outpatient clinic. Conclusions: The typical sports lesion patient is a male, 20 years old, practising soccer and with a lesion in the lower limbs which is most often an ankle sprain, and he (..) (AU)

Neumotórax a tensión / Tension pneumothorax

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Labor sanitaria con los ancianos: una experiencia educativa / Health work with the elderly. An educational experience

La educación sanitaria en la residencia geriátrica brinda la oportunidad al equipo multidisciplinar que la lleva a cabo de conseguir que los ancianos participen en actuaciones relacionadas con la prevención y la promoción de la salud. Se pretende, desde esta parte fundamental del día a día del anciano, que éste tome un papel protagonista, donde el aprendizaje y la enseñanza sean algo natural. Destacamos una serie de actividades de enfermería y de fisioterapia en las que la protagonista fundamental es la educación sanitaria. Con ello pretendemos únicamente, que el anciano siga despierto y saludable, equiparando aquí la salud, no tanto al bienestar biopsicosocial sino a definiciones más acordes con su verdadero significado: Estar alegre y seguir aprendiendo. Desde la perspectiva educativa del modelo del ciclo vital se hace patente el carácter procesual y continuo de la educación y el aprendizaje a lo largo de toda la vida de la persona. Por ello, queremos destacar la importancia de entender el aprendizaje como un proceso que se extiende hasta el final de la vida (AU)