Multidisciplinary consensus on nutritional and metabolic therapy in enhanced recovery after abdominal surgery programs: NutRICA Project.

BACKGROUND: The Enhanced Recovery After Surgery (ERAS) care pathways include evidence-based items designed to accelerate recovery after surgery. Interdisciplinarity is one of the key points of ERAS programs. OBJECTIVE: To prepare a consensus document among the members of the Nutrition Area of the Spanish Society of Endocrinology and Nutrition (SEEN) and the Spanish Group for Multimodal Rehabilitation (GERM), in which the goal is to homogenize the nutritional and metabolic management of patients included in an ERAS program. METHODS: 69 specialists in Endocrinology and Nutrition and 85 members of the GERM participated in the project. After a literature review, 79 statements were proposed, divided into 5 sections: 17 of general characteristics, 28 referring to the preoperative period, 4 to the intraoperative, 13 to the perioperative and 17 to the postoperative period. The degree of consensus was determined through a Delphi process of 2 circulations that was ratified by a consistency analysis. RESULTS: Overall, in 61 of the 79 statements there was a consistent agreement, with the degree of consensus being greater among members of the SEEN (64/79) than members of the GERM (59/79). Within the 18 statements where a consistent agreement was not reached, we should highlight some important nutritional strategies such as muscle mass assessment, the start of early oral feeding or pharmaconutrition. CONCLUSION: Consensus was reached on the vast majority of the nutritional measures and care included in ERAS programs. Due to the lack of agreement on certain key points, it is necessary to continue working closely with both societies to improve the recovery of the surgical patients.

Multidisciplinary consensus on nutritional and metabolic therapy in enhanced recovery after abdominal surgery programs: NutRICA Project. / Consenso multidisciplinar sobre la terapia nutricional y metabólica en los programas de recuperación intensificada en cirugía abdominal: Proyecto NutRICA.

BACKGROUND: The Enhanced Recovery After Surgery (ERAS) care pathways include evidence-based items designed to accelerate recovery after surgery. Interdisciplinarity is one of the key points of ERAS programs. OBJECTIVE: To prepare a consensus document among the members of the Nutrition Area of the Spanish Society of Endocrinology and Nutrition (SEEN) and the Spanish Group for Multimodal Rehabilitation (GERM), in which the goal is to homogenize the nutritional and metabolic management of patients included in an ERAS program. METHODS: 69 specialists in Endocrinology and Nutrition and 85 members of the GERM participated in the project. After a literature review, 79 statements were proposed, divided into 5 sections: 17 of general characteristics, 28 referring to the preoperative period, 4 to the intraoperative, 13 to the perioperative and 17 to the postoperative period. The degree of consensus was determined through a Delphi process of 2 circulations that was ratified by a consistency analysis. RESULTS: Overall, in 61 of the 79 statements there was a consistent agreement, with the degree of consensus being greater among members of the SEEN (64/79) than members of the GERM (59/79). Within the 18 statements where a consistent agreement was not reached, we should highlight some important nutritional strategies such as muscle mass assessment, the start of early oral feeding or pharmaconutrition. CONCLUSION: Consensus was reached on the vast majority of the nutritional measures and care included in ERAS programs. Due to the lack of agreement on certain key points, it is necessary to continue working closely with both societies to improve the recovery of the surgical patients.

Tunneled hemodialysis catheter-related bloodstream infections: a prospective multicenter cohort study from Spain.

PURPOSE: Catheter-related bloodstream infections (CRBSI) are common among patients undergoing long-term hemodialysis (HD) worldwide. The aim of this study was look into the incidence, epidemiology, and risk factors for CRBSI in four medical centers and Spanish dialysis facilities following a common protocol for insertion and management of tunneled hemodialysis catheters (THCs). METHODS: Prospective study including all THCs inserted from September-04 to October-05. Follow-up was from THC insertion to its withdrawal, onset of CRBSI or end of study. Data of all THCs, CRBSI episodes, and catheter complications were collected. A descriptive analysis of CRBSI incidence and etiology and multivariate Cox regression to identify risk factors for CRBSI was performed. RESULTS: A total of 130 THCs in 123 patients were inserted. There were 34 879 catheter-days. Twelve CRBSI in 11 patients with a CRBSI rate of 0.34/1000 catheter-days were recorded. CRBSI was caused by gram-positive coccus in 91.7% of the cases. Vascular cause of renal disease (HR 25.5 CI95% 5.5-117.2), and a previous THC (HR 5.1 CI95% 1.3-19.1) were identified as risk factors for CRBSI. CRBSI were satisfactorily resolved in 83.3% of the cases. Overall mortality was 14.6% (18/123), in two cases (2/11) death occurred within 30 days after CRBSI onset. CONCLUSIONS: Although some factors, such as vascular cause of renal disease and previous THC medical history, have been related to the onset of tunneled catheter-related bloodstream infections, the incidence of these bacteremia, mainly produced by gram-positive coccus, is low among hemodialysis patients and the mortality rate is not high.

The use of gene array technology and proteomics in the search of new targets of diseases for therapeutics.

The advent of functional genomics has been greatly broadening our view and accelerating our way in numerous medical research fields. The complete genomic data acquired from the human genome project and the desperate clinical need of comprehensive analytical tools to study complex diseases, has allowed rapid evolution of genomic and proteomic technologies, speeding the rate and number of discoveries in new biomarkers. By jointly using genomics, proteomics and bioinformatics there is a great potential to make considerable contribution to biomarker identification and to revolutionize both the development of new therapies and drug development process.

Tratamiento farmacológico de los trastoros de personalidad / Drug treatment with personality disorders

Revisamos la concepción mayoritaria de que los trastornos de la personalidad (TP) no son susceptibles de tratamiento farmacológico por tratarse de alteraciones que están relacionadas con la estructura de la personalidad y sus aspectos puramente psíquicos, haciendo posteriormente un repaso a las propuestas más generalizadas y contrastadas empíricamente acerca de las posibilidades terapéuticas de los psicofármacos en estos trastornos. Aunque la utilización de la terapia biológica se va convirtiendo en una práctica habitual, no existe ningún medicamento aprobado oficialmente para este tipo de afecciones. Con estos presupuestos, hacemos un breve repaso a las presuntas bases bioquímicas de los TP y sus dimensiones clínicas (esfera cognitiva, afectiva e impulsiva) para, a partir de ahí, hacer propuestas farmacológicas concretas, ordenadas en forma de algoritmo. Finalizamos esta exposición señalando el "conflicto de intereses" que se plantea entre lo conocido y lo que no sabemos aún sobre la fisiopatología de los trastornos mentales en general y de la personalidad en particular. Presentamos como riesgo el hecho de que las hipótesis bioquímicas consigan enraizarse como verdades absolutas, estimulando investigaciones alentadas (y financiadas) por las compañías farmacéuticas. Proponemos, finalmente, el cambio a un modelo centrado en el paciente, donde la descripción que éste hace de los efectos del fármaco sea el puntal esencial de intervención (AU)

This paper examines the prevaling opinión that personality disorders are resistant to drug treatment since they refer to personality structure and are purely psychological. Then, a review of the most relevant empirically-based theories about the therapeutic power of drug treatments in this respect is made. Although drug treatment is becoming a frequent treatment, no drug has yet been officially determined for this kind of disorders. Besed on the above statements, a brief review of biochemical bases of personality disorders and their clinical dimensions (cognitive, affective and behavioural signs), a number of suggestions for drug treatment are made in the form of an algorithm. There is a conflict of interests between what is known and what is unknown about physiopathology of mental disorders, particularly personality. There is the risk that biochemical hypothesis become absolute truths and the overlook corporative interests behin them. Finally, a suggestion is also made for a shift to a patient-centeres approach that highlights patient perceived effects of the drug should be taken into account at the time to intervene (AU)

Expósitos y sala de partos secretos / Foundlings and secret delivery rooms

Las ideas de la Ilustración suponen un importante avance de los planteamientos con respecto a la educación y la importancia que tienen los niños en la sociedad. Ello supone que comiencen a abrirse dispensarios, que se preste más atención a los cuidados del niño, que se contemplen medidas especiales de cuidado para los niños expósitos y para aquellas madres que no pudieran tener a sus hijos en el marco familiar. El artículo analiza la situación de los expósitos en A Coruña en los siglos XVIII-XIX teniendo en cuenta la atención prestada en el Hospital de La Caridad de A Coruña y en la Casa Maternidad de Lugo. Un resumen de este trabajo fue presentado como comunicación libre en el XVI Congreso Nacional de Enfermería de Cuidados Intensivos Pediátricos y Neonatales (AU)