Área de Atención Integrada de Riesgo Vascular: un nuevo modelo organizativo para el control global de los factores de riesgo / Integrated Management Area of Vascular Risk: A new organisational model for global control of risk factors

La enfermedad cardiovascular (ECV) es una causa importante de morbimortalidad que incrementa el coste asistencial. Actualmente existe un bajo grado de control de los principales factores de riesgo cardiovascular, a pesar de que disponemos de un buen arsenal terapéutico. Para lograr la mejora de esta realidad es fundamental la coordinación y participación multiprofesional. El desarrollo de nuevos modelos organizativos, como el Área de Atención Integrada de Riesgo Vascular, puede facilitar la armonización terapéutica y la unificación de los mensajes sanitarios ofrecidos por los distintos niveles asistenciales, basados en las guías de práctica clínica, con el fin de ofrecer una atención integrada y centrada en el paciente

Cardiovascular disease (CVD), is a major cause of morbidity and mortality that increases the cost of care. Currently there is a low degree of control of the main cardiovascular risk factors, although we have a good therapeutic arsenal. To achieve the improvement of this reality, a good coordination and multidisciplinary participation are essential. The development of new organizational models such as the Integrated Management Area of Vascular Risk can facilitate the therapeutic harmonization and unification of the health messages offered by different levels of care, based on clinical practice guidelines, in order to provide patient-centred integrated care

[Integrated Management Area of Vascular Risk: A new organisational model for global control of risk factors]. / Área de Atención Integrada de Riesgo Vascular: un nuevo modelo organizativo para el control global de los factores de riesgo.

Cardiovascular disease (CVD), is a major cause of morbidity and mortality that increases the cost of care. Currently there is a low degree of control of the main cardiovascular risk factors, although we have a good therapeutic arsenal. To achieve the improvement of this reality, a good coordination and multidisciplinary participation are essential. The development of new organizational models such as the Integrated Management Area of Vascular Risk can facilitate the therapeutic harmonization and unification of the health messages offered by different levels of care, based on clinical practice guidelines, in order to provide patient-centred integrated care.

Radiofrequency ablation of a posteroseptal atrioventricular accessory pathway in a left-sided tricuspid ring with Ebsteinlike anomaly in a patient with congenitally corrected transposition of the great arteries.

Radiofrequency ablation successfully eliminated a posteroseptal accessory pathway in a left-sided tricuspid ring with Ebsteinlike anomaly in a patient with a congenitally corrected transposition of the great arteries.

Six-month outcome in unstable angina patients without previous myocardial infarction according to the use of tertiary cardiologic resources. RESCATE Investigators. Recursos Empleados en el Síndrome Coronario Agudo y Tiempos de Espera.

OBJECTIVES: The study assessed whether varying accessibility of patients with unstable angina (UA) to coronary angiography and revascularization determined differing usages and outcomes. BACKGROUND: The appropriate use rate of coronary angiography and revascularization procedures in UA remains to be established. METHODS: A total of 791 consecutive patients with UA without previous acute myocardial infarction (AMI) admitted to four reference teaching hospitals (one with tertiary facilities) were followed for six months. End points were six-month mortality and readmission for AMI, UA, heart failure, or severe ventricular arrhythmias. RESULTS: Patients admitted to the tertiary hospital were 3.27 (95% confidence interval [CI] 2.32 to 4.62) times more likely to undergo coronary angiography after adjustment for comorbidity and severity than were those admitted to nontertiary facilities (overall six-month use rates 70.1% and 48.3%, respectively). Revascularization procedures were performed in 36.2% of patients in the tertiary hospital and 24.6% in the others (p = 0.0007); adjusted relative risk (RR) 2.37 (95% CI 1.55 to 3.63). Median delay for urgent coronary angiography was shorter in the tertiary hospital (24 h vs. 4 days, p < 0.0002). Six-month mortality and readmission rates were similar in tertiary and nontertiary hospitals: 3.9% versus 5.3% and 16.9% versus 21.2%, respectively. Adjusted RR of death or readmission for the nontertiary hospitals was 1.23 (95% CI 0.57 to 2.67). CONCLUSIONS: The use of coronary angiography and revascularization procedures in UA patients with no previous AMI is higher in tertiary than in nontertiary hospitals, but the more selective use of these procedures in nontertiary centers does not imply worse outcome.

[Nursing in the 18th century. The Santa Creu Hospital in Barcelona]. / Enfermería en el siglo XVIII. El hospital de Santa Creu de Barcelona.

Continuing a study regarding the development of nursing at the Santa Creu Hospital in Barcelona, the authors use the hospital history, Constitutions, edited in 1756, to show how nursing care was originally dispensed mostly by the Pares y Mares (Fathers and Mothers), lay persons who received this name to indicate the natural relationship established between the sick and themselves. Despite the possible moral value they contributed, the quality of health care was probably not very high, and the various religious orders that were destined to fill the health care vacuum did not begin to appear until the end of the century.

Increased synthesis of systemic prostacyclin in cirrhotic patients.

Urinary excretion of two prostacyclin metabolites was investigated in 48 subjects: 8 controls and 40 cirrhotics (9 without ascites, 22 with ascites and preserved renal function, and 9 with functional renal failure). Urinary 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha), believed to reflect renal prostacyclin production, was significantly increased in patients without ascites and in ascitic patients with preserved renal function, but cirrhotics with renal failure showed rates similar to controls. Excretion of 2,3-dinor-6-keto-PGF1 alpha (PGI-M), the major urinary metabolite of systemic prostacyclin, was increased in all groups of patients, including those with renal failure. A single dose of sulindac, a renal-sparing prostaglandin synthesis inhibitor, reduced PGI-M but not 6-keto-PGF1 alpha in 5 cirrhotic patients. This would be consistent with the predicted renal origin of the latter and the systemic origin of the former. Ascitic patients with high urinary excretion of PGI-M (above the median value) showed significantly lower mean arterial pressure and higher plasma renin activity and aldosterone than patients with excretion below the median. Urinary 6-keto-PGF1 alpha was higher in patients with low PGI-M. Finally, creatinine clearance corrected excretion of PGI-M, as an estimation of relative plasma levels correlates both with plasma renin activity and plasma aldosterone in the 31 subjects who presented with ascites. It is suggested that enhanced synthesis of systemic prostacyclin may influence hemodynamic changes in patients with liver cirrhosis. Overproduction of systemic prostacyclin in the absence of increased renal prostacyclin synthesis appears to be characteristic of patients with functional renal failure.

Effects of sulphasalazine, lysine acetylsalicylate and flurbiprofen on human spermatozoa.

PIP: 6 male volunteers under well-controlled conditions were administered daily doses of lysine acetylsalicylate 3600 mg, flurbiprofen 100 mg and 1000 mg sulphasalazine every 12 hours over 3 sequential 4-day periods. There was a 15 day interval between treatments. Samples of ejaculates were obtained at 12 hours, 7 days, and 14 days after the last dose. Sperm physical parameters and prostaglandin (PG) levels were determined. Head alterations were observed with flurbiprofen and tail alterations plus spermatic aggregations persisting 2 weeks after treatment with sulphasalazine. The 19-hydroxy PGEs showed a significant decrease for the 3 drugs. Changes in the number, morphology, and motility of spermatozoa were not related to the PG levels, whereas antifertility actions of sulphasalazine were related to its sulphapyridine moiety.^ieng

Comparative study of antiinflammatory drugs and sulphasalazine in relation to prostaglandin E and 19 hydroxylated prostaglandin E levels and human male fertility.

The effect of lysine salicylate, flurbiprofen and sulphasalazine on human seminal prostaglandin profiles of six normal individuals was studied. All of them were treated with pharmacological doses of the three agents for four days with rest periods of eighteen days in between. Sulphasalazine produced less prostaglandin (PG) inhibition relative to the other two antiinflammatory drugs but in contrast only sulphasalazine induced sperm changes. Infertility status associated with the ingestion of therapeutic levels of sulphasalaziane is not directly related to the endogenous PGEs and 19-OH PGEs, the major prostanoids in human semen. PG determinations were carried out using gas chromatographic (GC) techniques.