The textbook outcome for cholecystectomy: Is it a good quality tool for a low-morbidity procedure?

INTRODUCTION: Cholelithiasis is the most common hospital diagnosis of the digestive system, and its treatment, if symptomatic, is laparoscopic cholecystectomy. There is a growing need for comprehensive determination of postoperative outcomes and the efficiency of healthcare facilities. The "textbook outcome"(TO) indicates the quality of care commonly used in oncological procedures, obtained by adding several postoperative parameters, which informs whether a perfect result has been obtained. The main objective of this study is to determine the TO for cholecystectomy and to see the factors that influence its achievement. METHODS: Retrospective observational unicentric cohort study on patients who underwent cholecystectomy between 2018-2020. We defined TO as those patients who met the following premises: Clavien-Dindo complications < III, postsurgical stay less than the 75th percentile (<3 days), and no readmissions or mortality in the first ninety days. Perioperative characteristics were analyzed, and the patients were divided into two groups according to whether or not they achieved TO. We defined criteria for difficult cholecystectomy according to the operative report. RESULTS: The percentage of TO was 72% (342/475) (82.6% in elective surgery and 60.5% in urgent surgery). The univariate analysis showed that the following factors are associated with achieving TO: female sex, age <63 years, ASA risk < III, elective surgery, laparoscopic approach, and not difficult cholecystectomy. After multivariate analysis ASA < III (OR 2.39 CI95% 1.37-4.16), elective surgery (OR 2.77 CI95% 1.64-4.67), laparoscopic approach (OR 5.71 CI95% 2.89-11.30) and not to be difficult cholecystectomy (OR 0.42 CI95% 0.259-0.71) remained statistically significant. CONCLUSIONS: The TO is a healthcare quality tool that is simple to perform, easily interpretable, and helpful for evaluating quality in healthcare and comparing centers. It applies not only to oncological procedures but also to cholecystectomy.

Textbook outcome in urgent early cholecystectomy for acute calculous cholecystitis: results post hoc of the S.P.Ri.M.A.C.C study.

INTRODUCTION: A textbook outcome patient is one in which the operative course passes uneventful, without complications, readmission or mortality. There is a lack of publications in terms of TO on acute cholecystitis. OBJETIVE: The objective of this study is to analyze the achievement of TO in patients with urgent early cholecystectomy (UEC) for Acute Cholecystitis. and to identify which factors are related to achieving TO. MATERIALS AND METHODS: This is a post hoc study of the SPRiMACC study. It´s a prospective multicenter observational study run by WSES. The criteria to define TO in urgent early cholecystectomy (TOUEC) were no 30-day mortality, no 30-day postoperative complications, no readmission within 30 days, and hospital stay ≤ 7 days (75th percentile), and full laparoscopic surgery. Patients who met all these conditions were taken as presenting a TOUEC. OUTCOMES: 1246 urgent early cholecystectomies for ACC were included. In all, 789 patients (63.3%) achieved all TOUEC parameters, while 457 (36.6%) failed to achieve one or more parameters and were considered non-TOUEC. The patients who achieved TOUEC were younger had significantly lower scores on all the risk scales analyzed. In the serological tests, TOUEC patients had lower values for in a lot of variables than non-TOUEC patients. The TOUEC group had lower rates of complicated cholecystitis. Considering operative time, a shorter duration was also associated with a higher probability of reaching TOUEC. CONCLUSION: Knowledge of the factors that influence the TOUEC can allow us to improve our results in terms of textbook outcome.

Diagnostic value of ascites immunohistochemistry in carcinomatosis of unknown origin.

We present the case of a patient diagnosed with carcinomatosis when admitted urgently for an occlusive condition. It is the immunohistochemistry that clarifies which is the primary tumor. Sigma neoplasia was initially suspected to recur due to operative findings. It was surprising that the primary tumor was of pulmonary origin. It became known thanks to the immunohistochemical cytology of the ascetic fluid.

Textbook outcome in oncological gastric surgery: a systematic review and call for an international consensus.

BACKGROUND: Textbook outcome (TO) is a multidimensional measure used to assess the quality of surgical practice. It is a reflection of an "ideal" surgical result, based on a series of benchmarks or established reference points that may vary depending on the pathology in question. References to TO in the literature are scarce, and the few reports that are available were all published very recently. In the case of gastric surgery, there is no established consensus on the parameters that should be included in TO, a circumstance that prevents comparison between series. AIM: To present a review of the literature on TO in gastric surgery (TOGS) and to try to establish a consensus on its definition. MATERIAL AND METHODS: Following the PRISMA guide, we performed an unlimited search for articles on TOGS in the MEDLINE (PubMed), EMBASE and Cochrane, Latindex, Scielo, and Koreamed databases, without language restriction, updated on December 31, 2022. The inclusion criterion was any type of study assessing TO in adult patients after oncological gastric surgery. Selected studies were assessed, and TOGS was measured. The parameters used to assess the achievement of TOGS in selected studies were also recorded. RESULTS: Twelve articles were included, comprising a total of 44,581 patients who had undergone an oncological gastric resection. The median rate of TOGS was 38.6%. All the publications but one included mortality as a TO variable, showing statistically significant differences in favor of the group in which TOGS was achieved. All articles included the number of nodes examined in the surgical specimen, with the assessment of fewer than 15 being associated with a low rate of TOGS achievement in five studies (41.7%). The variable postoperative complications according to the Clavien-Dindo score was the most important cause of failure to achieve TOGS in four studies (33.3%). Seven articles (58.3%) found a significant increase in long-term survival in patients who obtained TO. Advanced age, elevated ASA, and Charlson score had a negative impact on obtaining TOGS. CONCLUSIONS: The standardization of TOGS is necessary to be able to establish comparable results between groups.

Perfiles clínicos en hospitalización psiquiátrica prolongada: reflexiones para un nuevo enfoque en el abordaje del trastorno mental grave / Clinical profiles in prolonged psychiatric hospitalization: reflections for a new approach in the treatment of serious mental illness

El acceso de los usuarios con trastorno mental grave (TMG) a los dispositivos sociosanitarios viene determinado por unos criterios preestablecidos que pueden estar opacando la existencia de perfiles clínicos con diferentes necesidades terapéuticas. En esta línea, desde el Centro San Juan de Dios de Ciempozuelos (CSJD), se ha realizado un estudio descriptivo de tipo transversal en el que se han encontrado cinco tipologías clínicas mediante la aplicación de un análisis de conglomerados en dos fases. En el estudio participaron 413 personas con TMG ingresadas en diferentes dispositivos de la Unidad de Cuidados Psiquiátricos Prolongados -UCPP- del CSJD (en función de su autonomía y necesidades) y que presentaban una media de edad de 53.78 años (95.4% varones y 4.4% mujeres) y altos niveles de institucionalización (media de 13.06 años). El diagnóstico principal encontrado fue el de esquizofrenia residual (38.3%; n= 158), seguido de esquizofrenia paranoide (26.6%; n= 110). También había un número significativo de trastornos de la personalidad (35 casos). Las cinco tipologías de usuarios se denominaron en función de sus características más destacadas: Rehab (R), Rehab Behav (RB), Young Care (YC), Old Care (OC) y Young Behav (YB). En función de estos resultados se debate la idoneidad de los recursos existentes a la par que se proponen alternativas que maximicen la efectividad de los mismos en relación a casos de TMG complejos, como los de trastorno límite de la personalidad. (AU)

Institutions dedicated to the care of serious mental illness (SMI) have admission criteria that determine the users who are admitted. A thorough analysis of the patients may reveal the existence of different clinical profiles with diverse therapeutic needs. In order to determine the existence of different clinical profiles in the UCPP of the Centro San Juan de Dios de Ciempozuelos (CSJD), a cross-sectional descriptive study was carried out, finding five clinical typologies by applying a two-stage cluster analysis. 413 people with SMI, admitted in different devices of the Prolonged Psychiatric Care Unit (according to their autonomy and needs), with a mean age of 53.78 years (95.4% males and 4.4% females) and high levels of institutionalization (mean 13.06 years), took part in the study. The main diagnosis found was residual schizophrenia (38.3%; n= 158), followed by paranoid schizophrenia (26.6%; n= 110). There was also a significant number of personality disorders (35 cases). The five typologies of users were named according to their most salient characteristics: Rehab (R), Rehab Behav (RB), Young Care (YC), Old Care (OC) and Young Behav (YB). A discussion on the implications of the determination of these profiles for a better use of existing resources is held. In addition, different alternatives for particularly difficult cases of SMI, such as borderline personality disorder, are proposed. (AU)

Textbook Outcome in Bariatric Surgery: Evolution During 15 Years in a Referral Center.

BACKGROUND: Textbook outcome (TO) is a multidimensional measure used to assess the quality of care. It is the "ideal" surgical result, based on a series of established indicators. In the field of bariatric surgery (BS), only one publication on TO is available. OBJECTIVES: To determine TO in our BS unit and identify the factors linked to TO. SETTING: University public hospital in Alicante (Spain). METHODS: Retrospective observational study of all primary BS was performed. TO for BS was defined in relation to the following features: no major postoperative complications (Clavien-Dindo >II), hospital stay <75th percentile, and no mortality or readmissions within 30 days of surgery. Comparative analysis of the characteristics of the TO and non-TO groups was performed, as well as univariate and multivariate logistic regressions, to identify the independent factors associated with obtaining TO. RESULTS: In 970 patients, TO was achieved in 71.5%. The hospital stay was the one that most affected achievement of TO. Analysis according to the type of procedure (sleeve gastrectomy and gastric bypass) did not reveal any differences between both procedures in terms of obtaining TO (71.5 vs 71.26%). Logistic regression identified smoking, heart disease, operative time, and upper gastrointestinal bleeding as independent factors associated with obtaining TO (p<0.05). Analysis of the annual evolution of TO reveals a progressive increase in its achievement (7.7-86.4%). CONCLUSION: In our series, TO was obtained in 71.5% of patients. The standardization of the technique and the experience gained over the years has improved our TO results.

Textbook outcome in colon carcinoma: implications for overall survival and disease-free survival.

BACKGROUND: Textbook outcome (TO) is a multidimensional quality management tool that uses a set of traditional surgical measures to reflect an "ideal" surgical result for a particular pathology. The aim of the present study is to record the rate of TO in patients undergoing elective surgery for colon cancer (CC). MATERIAL AND METHODS: Retrospective study of all patients undergoing scheduled CC surgery at a Spanish university hospital from September 2012 to August 2016. Patients with rectal cancer were excluded. The variables included in the definition of TO were: R0 resection, number of isolated nodes ≥ 12, no Clavien-Dindo ≥ IIIa complications, no prolonged stay, no readmissions, and no mortality in the first 30 days. The main objective of this study is to analyse the achievement of TO in these patients and to assess the relationship between TO and overall and disease-free survival. RESULTS: Five hundred and sixty-four patients were included in the study. TO was achieved in 49.8%. The sample had a mean age of 69 ± 11 years, and 60% were male. Female sex (OR 1.61; 95% CI 2.30-1.13), T3 and T4 classification (OR 2.50, 95% CI 4.59-1.36, and OR 2.55, 95% CI 5.21-1.24 respectively) and laparoscopic approach (OR 1.53, 95% CI 2.33-1.00) were independent factors that were significantly associated with achieving a TO. Patients who achieved TO had higher overall survival (p = 0.008) than those who did not. However, with regard to disease-free survival, no statistically significant differences were found (p = 0.303). CONCLUSION: TO is a useful, easy-to-interpret management tool for measuring oncological results and for predicting patient survival.

LOCATE-US: Indoor Positioning for Mobile Devices Using Encoded Ultrasonic Signals, Inertial Sensors and Graph-Matching.

Indoor positioning remains a challenge and, despite much research and development carried out in the last decade, there is still no standard as with the Global Navigation Satellite Systems (GNSS) outdoors. This paper presents an indoor positioning system called LOCATE-US with adjustable granularity for use with commercial mobile devices, such as smartphones or tablets. LOCATE-US is privacy-oriented and allows every device to compute its own position by fusing ultrasonic, inertial sensor measurements and map information. Ultrasonic Local Positioning Systems (U-LPS) based on encoded signals are placed in critical zones that require an accuracy below a few decimeters to correct the accumulated drift errors of the inertial measurements. These systems are well suited to work at room level as walls confine acoustic waves inside. To avoid audible artifacts, the U-LPS emission is set at 41.67 kHz, and an ultrasonic acquisition module with reduced dimensions is attached to the mobile device through the USB port to capture signals. Processing in the mobile device involves an improved Time Differences of Arrival (TDOA) estimation that is fused with the measurements from an external inertial sensor to obtain real-time location and trajectory display at a 10 Hz rate. Graph-matching has also been included, considering available prior knowledge about the navigation scenario. This kind of device is an adequate platform for Location-Based Services (LBS), enabling applications such as augmented reality, guiding applications, or people monitoring and assistance. The system architecture can easily incorporate new sensors in the future, such as UWB, RFiD or others.

Point-of-care capillary HbA1c measurement in the emergency department: a useful tool to detect unrecognized and uncontrolled diabetes.

BACKGROUND: Inpatient hyperglycaemia and diabetes mellitus (DM) are common and are associated with an increased risk of complications and mortality. The severity of hyperglycaemia determines the rate of complications in patients treated in the emergency department (ED). Our aim was to examine whether determination of the capillary haemoglobin A1c (HbA1c) is a reliable method for detecting unknown diabetes and poor glycaemic control in the ED. METHODS: A prospective observational study was conducted in adult (>18 years) patients treated in a single-centre ED. We compared the results of HbA1c levels measured by Bio-Rad in2it point-of-care device on a capillary blood sample and by the hospital laboratory. RESULTS: A total of 187 ED patients with an average age of 57.1 ± 19.2 years were studied. The mean HbA1c value was 5.78 ± 1.26 % by capillary POC testing and 6.10 ± 1.12 % by the hospital laboratory (correlation = 0.712, P < 0.001). A total of 17.1 % of cases had a prior diagnosis of DM. The diagnosis of DM (plasma glucose > 126 mg/dL and/or HbA1c > 6.5 %) was made in ten (5.4 %) additional cases (prior undiagnosed DM) for a total prior DM prevalence of 22.5 % (95 % CI 16.4-28.5 %). Capillary HbA1c detected 11 additional cases of unknown DM (5.9 %). A capillary HbA1c value greater than 6 % has a sensitivity of 85.7 % and specificity of 85.3 % for the screening of DM. CONCLUSIONS: Determination of the capillary HbA1c in the ED is a reliable, fast, and simple system for the screening of unknown or uncontrolled DM.

Psychometric Properties of the Mexican Version of the Mindful Attention Awareness Scale (MAAS) / Propiedades psicométricas de la versión mexicana de la escala de atención Plena (MAAS)

This study presents a translation of the Mindful Attention Awareness Scale (MAAS) into Mexican Spanish, and examines its psychometric properties as well as its relationship with socio-demographic variables. The MAAS measures the frequency with which people experience mindful states. A sample of N = 622 healthy adult Mexicans completed the MAAS. A smaller sub-sample (n=195) completed the Five-Facet Mindfulness Questionnaire (FFMQ), a well-known mindfulness measure, to obtain concurrent validity. Exploratory factor analysis (EFA) revealed a one-factor solution, and reliability coefficients were adequate. Confirmatory factor analysis (CFA) showed adequate goodness of fit indexes. Moreover, relationships between Mexican Spanish MAAS scores and socio-demographic variables were also explored, and differences between-groups were found in mean scores both in alcohol consumers and religious practitioners. No other significant differences between groups were found. Results suggest that the Mexican version of the MAAS is a reliable and valid instrument to use with a healthy adult Mexican sample.

Este estudio presenta una traducción de la Mindful Attention Awareness Scale (Escala de Atención Plena) al español mexicano y examina sus propiedades psicométricas, así como su relación con variables sociodemográficas. La Escala de Atención Plena mide la frecuencia con la que las personas experimentan estados de atención plena. Una muestra de N=622 adultos mexicanos sanos completaron la Escala de Atención Plena. Una submuestra más pequeña (n=195) completó el Cuestionario de Cinco Facetas de la Atención Plena, el cual es una escala bien conocida de atención plena, para obtener validez concurrente. El análisis factorial exploratorio reveló una solución unifactorial y los coeficientes de confiabilidad fueron adecuados. El análisis factorial confirmatorio mostró índices adecuados de bondad de ajuste. Además, también se exploraron las relaciones entre la versión Mexicana del MAAS y variables sociodemográficas, encontrándose diferencias entre grupos tanto en consumidores de alcohol como en practicantes de religión. No se encontraron otras diferencias significativas entre grupos. Los resultados sugieren que la versión mexicana de la MAAS es un instrumento confiable y válido para utilizarse con población mexicana adulta y sana.

Cardiovascular risk in women attending primary care centres: baseline data of the EVA study.

BACKGROUND: The purpose of this study was to determine the prevalence of hypertension, cardiovascular risk factors and target organ damage using baseline data from the EVA study. METHODS: EVA is a 5-year multicentre prospective study of women aged between 40 and 70 years attending primary care centres in a rural-urban area in the north of Spain. The recruitment period was between October 2009 and January 2010. The following variables were analysed: associated cardiovascular risk factors, target organ damage and cardiovascular or renal disease defined according to the 2007 European Society of Hypertension and the European Society of Cardiology Guidelines (2007 ESH/ESC 2007). Blood pressure <140/90 mmHg and <130/80 in diabetics were considered target blood pressure values. Cardiovascular risk was stratified according to the 2007 ESC-ESH guidelines. RESULTS: The study sample comprised of 903 women with a mean age of 59.6 ± 8 years. The prevalence of hypertension, Type 2 diabetes and dyslipidaemia was 45.6, 13.3 and 41.7%, respectively. Target organ damage affected 17.6% of women and manifested as microalbuminuria (1.8%), slight increase in plasma creatinine (1.6%) and left ventricular hypertrophy (2.9%). Overall, 9.3% had cardiovascular disease, 3.4% coronary heart disease, 1.8% heart failure, 1.8% peripheral artery disease and 1.4% renal disease; 2.2% of patients had experienced a stroke. The prevalence of cardiovascular risk factors in hypertensive women (HT) with respect to non-hypertensive women (NHT) was as follows: obesity 44.7 versus 18.9%, dyslipidaemia 48.8 versus 35.8% and Type 2 diabetes 21.8 versus 6.1%. The target organ damage was more prevalent in hypertensive women: 27.3 versus 9.4%. Cardiovascular disease was present in 14.8% of HT and 4.7% of NHT. High or very high cardiovascular risk affected 65.3% of HT and 26.9% of NHT. CONCLUSIONS: Four in 10 women attending primary care centres had a high or very high cardiovascular risk. Percentages of classic cardiovascular risk factors were higher in HT than in NHT and increased significantly with age. The most commonly used drugs were renin-angiotensin system blockers and diuretics.