Clinical Proof of Concept for Stabilization of Tracheostomy Tubes Using Novel DYNAtraq Device.

Introduction: Tracheostomy is one of the most common surgical strategies in intensive care units (ICU) and provides relevant clinical benefit for multiple indications. However, the complications associated with its use range from 5 to 40% according to different series. The risk of these complications could be reduced if fixation strategies and alignment of the tracheostomy tube with respect to the tracheal axis are improved. Aim: To build a functional device of technological innovation in respiratory medicine for the fixation and alignment of tracheostomy cannula (acronym DYNAtraq) and to evaluate its feasibility and safety in a pilot study in mechanically ventilated patients. Methods: Study carried out in four phases: (1) design engineering and functional prototyping of the device; (2) study of cytotoxicity and tolerance to the force of traction and push; (3) pilot study of feasibility and safety of its use in tracheostomized and mechanically ventilated patients; and (4) health workers satisfaction study. Results: The design of the innovative DYNAtraq device included, on the one hand, a connector with very little additional dead space to be inserted between the cannula and the ventilation tubes, and, on the other hand, a shaft with two supports for adhesion to the skin of the thorax with very high tolerance (several kilograms) to pull and push. In patients, the device corrected the malpositioned tracheostomy tubes for the latero-lateral (p < 0.001) and cephalo-caudal angles (p < 0.001). Its effect was maintained throughout the follow-up time (p < 0.001). The use of DYNAtraq did not induce serious adverse events and showed a 70% protective effect for complications (RR = 0.3, p < 0.001) in patients. Conclusion: DYNAtraq is a new device for respiratory medicine that allows the stabilization, alignment and fixation of tracheostomy tubes in mechanically ventilated patients. Its use provides additional benefits to traditional forms of support as it corrects misalignment and increases tolerance to habitual or forced movements. DYNAtraq is a safe element and can reduce the complications of tracheostomy tubes.

Tumor infrecuente como causa de dispepsia / Rare tumor as a cause of dyspesia

El pólipo fibroide inflamatorio gástrico es una entidad clínico-patológica rara, la cual representa una incidencia del 0,1 % de todos los pólipos gástricos.Con mayor frecuencia afecta a adultos en un amplio rango de edad, cuyo pico de incidencia es entre la sexta y séptima décadas de la vida. Las lesiones son predominantemente asintomáticas y se detectan incidentalmente en la endoscopia o en las imágenes realizadas por causas no relacionadas. Ocasionalmente, los pólipos fibroides provocan sintomatología, ya sea por su gran tamaño que causa obstrucción de la salida gástrica, o por la erosión de la mucosa que se presenta con sangrado gastrointestinal superior manifiesto u oculto.

The gastric inflammatory fibroid polyp is a rare clinical-pathological entity, representing an incidence of 0.1% of all gastric polyps. It most frequently affects adults in a wide age range, and its incidence peak is between the sixth and seventh decades of life. The lesions remain predominantly asymptomatic and are detected incidentally on endoscopy or imaging for unrelated causes. Occasionally, fibroid polyps cause symptoms due to their large size causing gastric outlet obstruction, or due to mucosal erosion presenting with overt or occult upper gastrointestinal bleeding.

Living with disabling chronic pain: results from a face-to-face cross-sectional population-based study.

OBJECTIVES: To estimate the prevalence of disabling chronic pain (DCP) in Spanish adults, to analyse its characteristics, to determine its multimorbidity and to identify its associated factors. SETTINGS: 2011 Andalusian Health Survey, a cross-sectional population survey based on face-to-face home interviews. PARTICIPANTS: 6507 people aged 16 years or older and living in Andalusia, Spain. OUTCOMES: The response variable was disabling chronic pain. Multivariate multinomial logistic regression models were used to analyse the association of factors with disabling chronic pain. The sample design was considered throughout the statistical analysis. RESULTS: The prevalence of disabling chronic pain in the Spanish adult population was 11.36% (95% CI 11.23 to 11.49), while that of non-disabling chronic pain was 5.67% (95% CI 5.57 to 5.77). Disabling chronic pain was associated with high multimorbidity (especially in women (51%) and in the elderly (70%) with three or more additional chronic diseases), as well as with disadvantaged social status (such as female gender (OR=2.12), advanced age (OR10-year increase=1.28), unemployment (OR=1.33), manual work (OR=1.26), low income (OR=1.14) and reduced emotional social support (OR=1.04)). Other influential factors were tobacco consumption (OR=1.42), sleeping ≤7 hours (OR=1.2)], environmental or work conditions (OR=1.16) and quality of life (ORmental=1.21, ORphysical=2.37). CONCLUSIONS: The population with disabling chronic pain was associated with multimorbidity, vulnerable social status and an impaired quality of life. In contrast, the population with non-disabling chronic pain showed almost no differences when compared with the population without chronic pain. The association between DCP and mental disorders highlights the need for psychosocial services in the management of chronic pain.

Preferences of caregivers and patients regarding opioid analgesic use in terminal care.

CONTEXT: Patients and caregivers participate in decision-taking, and their views should be considered in the preparation of Clinical Practice Guidelines (CPGs). We involved them in the development of a CPG on the safe use of major opioids. OBJECTIVE: To identify the values and preferences of patients and caregivers on the use of opioids and the desired outcomes, to investigate motives for the acceptance/rejection of opioid therapy, and to evaluate their beliefs and information about these drugs. METHODS: A qualitative study was conducted using semi-structured interviews in an Andalusian population of terminal patients and caregivers (N = 42). Study variables included the role, diagnosis, and adherence to treatment. Content and validity analyses were performed. RESULTS: Less than one-third of participants recognized the term opioid. Among these, false beliefs were held related to the addictive nature of these drugs, their exclusive use in terminal cases and at the end of life, and their association with premature death. The information received was very general: it was known that they are "useful for pain," and some were informed about the administration route, composition, and habituation. Participation in decision making was usually limited to reporting symptoms to the physician. CONCLUSION: These patients and caregivers demonstrated a preference for pain alleviation by opioid treatment and gave negative assessments on adverse digestive effects that can cause this treatment to be abandoned. They expressed interest in receiving more information and in participating in therapeutic decision making, and they reported erroneous beliefs and a lack of information about the effects of these drugs.

[Motives that condition use of the health services by over-users: study with focus groups]. / Motivos que condicionan el uso de los servicios sanitarios por parte de los pacientes hiperfrecuentadores: estudio con grupos focales.

BACKGROUND: Much is known about the profile of over-users and the cost of their demands, but their personal views about the reasons for their behaviour have been little examined. AIMS: To identify the reasons over-users give for their behaviour. DESIGN: Qualitative analysis of transcriptions of video-recorded focus group meetings. SETTING: Two urban primary care clinics of the Andalusian Health Service in Seville, Spain. PARTICIPANTS: Twelve women and 15 men; 9 between 45 and 65 years old and 18 over 65. Average of 55 attendances at the health centre (HC) during the previous year. Group meetings were held in Seville between November 26, 2003 and December 12, 2003. METHODS: Inductive analysis of focus group interview transcriptions. RESULTS: Most over-users attend their HC because of perception of problems (psychological, physical) and their belief that they will find effective help from the health services. Factors such as their relationships with health staff or organisation of care are perceived as barriers or facilitators of health service use. Low family and social support are perceived as important factors in seeking help in primary care. CONCLUSIONS: Health services should bear in mind these motives of over-users, on designing and introducing support systems to manage demand more rationally and effectively. These systems could be based on new technology (internet and telephone information and consulting) and the cooperation of other professionals, such as pharmacists or nurses.

Motivos que condicionan el uso de los servicios sanitarios por parte de los pacientes hiperfrecuentadores: estudio con grupos focales / Motives that condition use of the health services by over-users: study with focus groups

Antecedentes. Se conoce bastante del perfil de los hiperfrecuentadores (HF) y los costes de sus demandas, pero su opinión sobre los motivos de su conducta ha sido poco investigado. Objetivos. Identificar las razones autopercibidas de la conducta de los HF. Diseño. Análisis cualitativo de transcripciones registradas en vídeo de reuniones con grupos focales. Emplazamiento. Dos centros de salud del Servicio Sanitario Público de Andalucía en Sevilla. Participantes. Participaron 12 mujeres y 15 varones, 9 personas entre 45 y 65 años y 18 mayores de 65 años, con una media de 55 visitas al centro en el último año. Los grupos fueron realizados en Sevilla entre el 26 de noviembre y el 12 de diciembre de 2003. Método. Análisis inductivo de las trascripciones de entrevistas de grupos focales. Resultados. Las razones principales de los HF para acudir a atención primaria son la percepción de problemas (psicológicos, físicos) junto con la creencia de encontrar ayuda efectiva en los servicios sanitarios. Factores como la relación con los profesionales o la organización de los servicios se perciben como factores que predisponen dificultan o facilitan la utilización, y un apoyo familiar o social escaso se considera importante para buscar ayuda en atención primaria. Conclusiones. Los servicios sanitarios deberían tener en cuenta estos motivos autopercibidos al diseñar e implementar sistemas de apoyo para utilizar la demanda de forma más racional y efectiva, basándose en nuevas tecnologías (información y consultas por internet y teléfono) y en la cooperación de otros profesionales (farmacéuticos, enfermeras)

Background. Much is known about the profile of over-users and the cost of their demands, but their personal views about the reasons for their behaviour have been little examined. Aims. To identify the reasons over-users give for their behaviour. Design. Qualitative analysis of transcriptions of video-recorded focus group meetings. Setting. Two urban primary care clinics of the Andalusian Health Service in Seville, Spain. Participants. Twelfe women and 15 men; 9 between 45 and 65 years old and 18 over 65. Average of 55 attendances at the health centre (HC) during the previous year. Group meetings were held in Seville between November 26, 2003 and December 12, 2003. Methods. Inductive analysis of focus group interview transcriptions. Results. Most over-users attend their HC because of perception of problems (psychological, physical) and their belief that they will find effective help from the health services. Factors such as their relationships with health staff or organisation of care are perceived as barriers or facilitators of health service use. Low family and social support are perceived as important factors in seeking help in primary care. Conclusions. Health services should bear in mind these motives of over-users, on designing and introducing support systems to manage demand more rationally and effectively. These systems could be based on new technology (internet and telephone information and consulting) and the cooperation of other professionals, such as pharmacists or nurses

Randomised trial of long term effect of acupuncture for shoulder pain.

The objective of the study is to compare the efficacy of electro-acupuncture with placebo-acupuncture for the treatment of shoulder pain. This study comprised of a prospective, randomized, placebo controlled trial, with independent evaluator set in a Public primary care clinic in Spain. The participants are patients aged from 25 to 83 years with shoulder pain. Patients were randomly allocated to two treatments over eight weeks, with electro-acupuncture or skin non-penetrating placebo-acupuncture, both able to take diclofenac if needed for intense pain. Primary outcome measure was the difference between groups in pain intensity (visual analogue scale-VAS). Secondary outcomes were differences between groups in pain intensity measured by Lattinen index, in range of motion (goniometer), functional ability (SPADI), quality of life (COOP-WONCA charts), NSAIDS intake, credibility (Borkoveck and Nau scale) and global satisfaction (10 points analogue scale). Assessments were performed before, during and three and six months after treatment. At six month follow-up after treatment the acupuncture group showed a significantly greater improvement in pain intensity compared with the control group [VAS mean difference 2.0 (95% CI 1.2-2.9)]. The acupuncture group had consistently better results in every secondary outcome measure than the control group. Acupuncture is an effective long-term treatment for patients with shoulder pain (from soft tissues lesions) in a primary care setting.