Frailty among older Hispanics living in the United States: A scoping review.

A scoping review was conducted to identify the available evidence about frailty among older Hispanics living in the U.S. using the Integral Model of Frailty. A not time-limited search was conducted in five peer-reviewed databases. Identified factors associated with frailty among older Hispanics are presented in four categories: (1) Characteristics and prevalence of frailty, (2) Life course determinants of frailty, (3) Comorbidities associated with frailty, and (4) Adverse outcomes of frailty. A total of 1030 articles were identified, and 37 articles were included in the scoping review. Most studies measured frailty based on the Fried Frailty Phenotype (59.5%, n= 22) and had a longitudinal design (64.9%, n= 24). The overall prevalence of frailty among Hispanics ranged from 4.3% to 37.1% (n= 20 studies). Further research is needed that targets Hispanics from different backgrounds in the U.S., particularly those that are high in number (i.e., Mexicans, Puerto Ricans, and Central Americans).

A consensus statement on how to conduct inclusive health research.

BACKGROUND: The active involvement of people with intellectual disabilities in research, or inclusive research, is relatively common. However, inclusive health research is less common, even though it is expected to lead to appropriate healthcare and increased quality of life. Inclusive health research can build upon lessons learned from inclusive research. METHOD: A total of 17 experts on inclusive (health) research without intellectual disabilities and 40 experts with intellectual disabilities collaborated in this consensus statement. The consensus statement was developed in three consecutive rounds: (1) an initial feedback round; (2) a roundtable discussion at the 2016 International Association for the Scientific Study of Intellectual and Developmental Disabilities World Congress; and (3) a final feedback round. RESULTS: This consensus statement provides researchers with guidelines, agreed upon by experts in the field, regarding attributes, potential outcomes, reporting and publishing, and future research directions, for designing and conducting inclusive health research. CONCLUSIONS: Consensus was reached on how to design and conduct inclusive health research. However, this statement should be continuously adapted to incorporate recent knowledge. The focus of this consensus statement is largely on inclusive health research, but the principles can also be applied to other areas.

Infiltración con toxina botulínica para el control del dolor en cáncer de mama / Botulinum toxin infiltration for breast cancer pain control

Introducción. El dolor es frecuente entre las pacientes con cáncer de mama, siendo la causa principal de la baja calidad de vida. La toxina botulínica (TB) podría ser una opción de tratamiento en estas pacientes durante la reconstrucción mamaria o en el síndrome de dolor postmastectomía. Muy pocos autores han estudiado su efectividad en el tratamiento del dolor. Hipótesis. La infiltración con TB en el músculo pectoral provoca una inhibición del espasmo muscular mejorando el dolor. Objetivos. Valoración de la efectividad de la TB en el control del dolor, en la reconstrucción con expansor tisular, implantes mamarios y en el dolor crónico. Material y métodos. Tipo de estudio: cuasiexperimental. La muestra incluyó 89 pacientes seleccionados de forma no aleatorizada entre junio de 2009 y febrero de 2011. Todas presentaban cáncer de mama con enfermedad controlada y contractura dolorosa de pectoral mayor. Valoración: exploración clínica y la puntuación en la escala EVA previo y posterior a la infiltración. Resultados. El 21% fueron infiltradas durante la reconstrucción, el 16% portaban prótesis mamaria y el 63% tenían dolor crónico. El dolor nociceptivo fue más frecuente en el grupo de expansor (73,6%) y el mixto en dolor crónico (89,2%). La puntuación en la escala EVA inicial fue más alta para el grupo de expansor que obtuvo mayores descensos posteriores a la infiltración. Conclusiones. La infiltración del músculo pectoral mayor con TB tipo A mejora el dolor en el cáncer de mama, tanto durante la fase de reconstrucción mamaria con expansor como en las pacientes con implantes y en las que presentan síndrome de dolor postmastectomía (AU)

Introduction. Pain is common among patients with breast cancer, it being the leading cause of poor quality of life. Botulinum toxin (BT)may be a treatment option in these patients during breast reconstruction or in post-mastectomy pain syndrome. Very few authors have studied its effectiveness in treating pain. Hypothesis. Infiltration with BTin the breast muscle causes an inhibition of the muscle spasm, thus improving the pain. Objectives. To assess the effectiveness of BT in pain control in reconstruction with tissue expanders, breast implants and in chronic pain. Material and methods. The study had a quasi-experimental design. The sample included 89 randomly selected patients between June 2009 and February 2011. All had breast cancer with controlled disease and painful contracture of the pectoralis major. The evaluation was performed by clinical examination and score on the visual analogue scale (VAS) before and after the infiltration. Results. A total of 21% had undergone infiltration during reconstruction; 16% had a breast prosthesis and 63% had chronic pain. Nociceptive pain was more frequent in the expander (73.6%) and mixed chronic pain (89.2%) group. Initial VAS score was higher for the expander group that obtained greater declines after the injection. Conclusions. Infiltration of the pectoral muscle with BT type A improves pain in breast cancer subjects, both during breast reconstruction with expander and in patients with implants and in those with post-mastectomy pain syndrome (AU)

El papel de la escuela de linfedema y la cinesiterapia en la prevención y el tratamiento del linfedema / The role of the school of lymphedema and kinesitherapy in the prevention and treatment of lymphedema

La elevada prevalencia de linfedema con su impacto en la calidad de vida y la eficacia incompleta de las terapias actuales hace aconsejable la instauración de programas de prevención que hagan posible una detección y un tratamiento precoz. La escuela de linfedema tiene como objetivo el de instruir a los pacientes de riesgo y a pacientes afectados en las medidas de prevención, autocuidado y en la identificación precoz del linfedema o sus complicaciones. Los ejercicios activos forman parte de los programas de prevención del linfedema y del tratamiento del mismo en la denominada terapia física compleja. Estudios recientes muestran que además de los ejercicios habituales recomendados la elaboración personalizada de protocolos que engloben actividad aeróbica, de resistencia y de flexibilización están indicados ya que ni desencadenan ni exacerban el linfedema, pero contribuyen a aumentar la calidad de vida de estos pacientes (AU)

The high prevalence of lymphedema along with its impact on quality of life and incomplete efficacy of current therapies makes the establishment of prevention programs that enable detection and early treatment recommendable. The School of Lymphedema aims to educate the at-risk and affected patients regarding preventive measures, self-care and early identification of lymphedema and its complications. Active exercises are part of lymphedema prevention programs and its treatment in the so-called complex physical therapy. Recent studies show that in addition to the recommended regular exercises, development of personalized protocols including aerobic, resistance and flexibility exercises is indicated since they neither trigger nor exacerbate lymphedema but contribute to improving the quality of life of these patients (AU)

[Effect of the do-not-resuscitate orders on the critical patient care plan]. / El efecto de la orden de no reanimación cardiopulmonar en el plan de atención al paciente crítico.

BACKGROUND: Do-not-resuscitate (DNR) orders are physician orders that refer to not initiating cardiopulmonary resuscitation in a patient who is in cardiac or respiratory arrest. However, these orders often imply other treatment modifications. AIMS: To analyze the effect that do-not-resuscitate orders have on the care plan of the critically ill patient; and to analyze if differences exist in the nursing workload (NEMS), before and after DNR prescription. METHOD: This descriptive study analyzed the care plan of 50 critically ill adult patients, before and after an electronic DNR order. RESULTS: After the DNR order was written the following variations were found: treatment was withdrawn in 30 patients; initiated in 6; both withdrawn and initiated in 12 patients; and there were no changes in their treatment in 2 patients. Specific modifications were: respiratory support: invasive mechanical ventilation was withdrawn in 7 patients, and non-invasive ventilation in 3, and the FiO(2) of the ventilator was reduced in 15 patients on the day of death; circulatory support: in 10 patients vasoconstrictor drugs were withdrawn and in one patient this therapy was initiated; inotropic drugs were withdrawn in 3 patients and initiated in 2 patients; extrarenal depuration hemofiltration was withdrawn in 4 patients and initiated in 2. The NEMS scores decreased on the patients after the order was written (36.20-34.62; p = 0.03). CONCLUSIONS: Do-not-resuscitate orders have an effect on the care plan of the critically ill adult patient. Also, although the NEMS scores decrease after the order, the nursing workload remains the same due to an increase in the psychosocial intervention with patient and family.

El efecto de la orden de no reanimación cardiopulmonar en el plan de atención al paciente crítico / Effect of the do-not-resuscitate orders on the critical patient care plan

Introducción. La orden de no resucitación es una medida referida estrictamente a la no realización de maniobras de reanimación cardiopulmonar (RCP), sin embargo se observa que habitualmente implica modificaciones en el tratamiento. Objetivos. Analizar el efecto que tiene la orden de no RCP en el plan de atención al paciente crítico y analizar si existen diferencias en la carga de trabajo de enfermería (Nine Equivalents of Nursing Manpower Use Score [NEMS]) antes y después de la orden de no RCP. Método. Este estudio descriptivo analizó el plan de atención de 50 pacientes críticos antes y después de la orden electrónica de no RCP. Resultados. Las variaciones encontradas después de la firma de la orden de no RCP fueron la retirada de tratamientos en 30 pacientes, la instauración en 6, en 12 tanto se retiraron como se iniciaron tratamientos y en 2 no hubo cambios. Se encontraron modificaciones en el soporte ventilatorio, en la administración de fármacos vasoactivos y en la depuración extrarrenal. Soporte ventilatorio: a 7 pacientes se les retiró la ventilación invasiva, a 3 la ventilación no invasiva y a 15 se les disminuyó la fracción inspiratoria de oxígeno del respirador el día del exitus. Fármacos vasoactivos: en 10 pacientes se retiró el tratamiento vasoconstrictor y en uno se instauró, los inotrópicos se retiraron en 3 pacientes y se instauraron en 2. Depuración extrarrenal: en 4 pacientes se retiró y en 2 se inició. La puntuación NEMS disminuyó después de la orden (36,20-34,62; p = 0,030). Conclusiones. La orden de no RCP tiene un efecto en el plan de atención al paciente crítico. Por otro lado, aunque la puntuación NEMS disminuye ligeramente después de la firma, la carga de trabajo de enfermería se mantiene al incrementarse la atención psicosocial al paciente y a la familia

Background. Do-not-resuscitate (DNR) orders are physician orders that refer to not initiating cardiopulmonary resuscitation in a patient who is in cardiac or respiratory arrest. However, these orders often imply other treatment modifications. Aims. To analyze the effect that do-not-resuscitate orders have on the care plan of the critically ill patient; and to analyze if differences exist in the nursing workload (NEMS), before and after DNR prescription. Method. This descriptive study analyzed the care plan of 50 critically ill adult patients, before and after an electronic DNR order. Results. After the DNR order was written the following variations were found: treatment was withdrawn in 30 patients; initiated in 6; both withdrawn and initiated in 12 patients; and there were no changes in their treatment in 2 patients. Specific modifications were: respiratory support: invasive mechanical ventilation was withdrawn in 7 patients, and non-invasive ventilation in 3, and the FiO2 of the ventilator was reduced in 15 patients on the day of death; circulatory support: in 10 patients vasoconstrictor drugs were withdrawn and in one patient this therapy was initiated; inotropic drugs were withdrawn in 3 patients and initiated in 2 patients; extrarenal depuration hemofiltration was withdrawn in 4 patients and initiated in 2. The NEMS scores decreased on the patients after the order was written (36.20-34.62; p = 0.03). Conclusions. Do-not-resuscitate orders have an effect on the care plan of the critically ill adult patient. Also, although the NEMS scores decrease after the order, the nursing workload remains the same due to an increase in the psychosocial intervention with patient and family

[Cefminox versus cefotaxime in the treatment of complicated urinary tract infection]. / Cefminox versus cefotaxima en el tratamiento de la infección urinaria complicada.

A comparative study of Cefminox, a new cefamicin, and Cefotaxime was conducted to evaluate the efficacy and safety of the former in the treatment of complicated urinary infection, and to correlate in both cases the bacteriological response with isolates MICs. To this end a phase III, randomized, blind and controlled clinical trial was conducted in 22 patients who met the study's preestablished criteria, 19 of which were evaluable. Both treatments achieved 100% clinical efficacy, while microbiological eradication was accomplished in 90.9% patients treated with Cefminox and 75% patients who received the comparator. Cefminox shows greater in vivo activity than that expected for the MICs, excellent efficacy and safety.

Genitourinary malakoplakia.

Between 1973 and 1991, 13 patients with malakoplakia (MKP) have been diagnosed and treated. The lesions involved all sites in the genitourinary tract; 2 patients had multiple and 11 had single lesions. Treatment was based on 2 criteria: (a) pharmacological treatment with trimethoprim-sulphamethoxazole and/or ascorbic acid and/or bethanechol chloride; (b) excision of the MKP lesion either endoscopically or by open surgery. Two patients died (1 from multiple MKP and the other from a myocardial infarct); the remainder did well. The pathogenic, diagnostic and therapeutic aspects of the disease are discussed.

[Multilocular cystic renal adenocarcinoma]. / Adenocarcinoma renal quístico multilocular.

On detecting a complex cystic renal mass, we are faced with the problem of making the differential diagnosis from a variety of diseases, some of very distinct nature and prognosis. Surgical exploration may occasionally be warranted to make the diagnosis since no radiological or analytical method, including cytological analysis of its content, is absolutely reliable. A 46-year-old male patient with multicystic renal adenocarcinoma is described. We discuss the diagnostic and therapeutic dilemmas that arise on detecting a multilocular renal mass in an adult patient.

[A Foley-type catheter with a steerable tip]. / Sonda de tipo Foley con extremo dirigido.

Permanent bladder catheterization for medical or social reasons increases the risk of complications, especially urinary infection. We evaluated the usefulness of the balloon catheter with a steerable intravesical tip in reducing the volume of residual urine between the bladder neck and the balloon of the conventional Foley catheter. The results show that this new catheter affords no additional advantage over the conventional catheter.

[Incidence of different types of hypercalciuria in the Madrid area. Demographic features]. / Incidencia de los distintos tipos de hipercalciuria en el área de Madrid. Características demográficas.

A study to determine the incidence of idiopathic hypercalciuria was performed in 110 patients (59 females, 51 males). Classification of this metabolic disorder according to its different types revealed the following incidence: 50% for absorptive hypercalciuria, 14.5% for hypercalciuria from loss of renal phosphates, and 30% for renal hypercalciuria. Insufficient biochemical data with a significant value did not permit classification of 6.3%. Analysis of distribution according to sex revealed a similar incidence (50%) for males and females for absorptive hypercalciuria, a prevalence in men (71%) for hypercalciuria due to loss of renal phosphates, and a prevalence in females (64.7%) for renal hypercalciuria. However, correction of these data according to the male to female ratio of our study population revealed renal hypercalciuria to be more prevalent in females whereas absorptive hypercalciuria and hypercalciuria from loss of renal phosphates were more prevalent in men. Analysis of distribution according to age revealed a direct relationship between the increased incidence of renal hypercalciuria and patient age.

[Complications in kidney transplant: our experience in 107 cases]. / Complicaciones en el trasplante renal: nuestra experiencia en 107 casos.

We introduce our case material on urological complications occurred in 107 renal transplants, 102 of which were from corpse donors and 5 form live donors. The techniques used for the reconstruction of the urinary tract were: extravesical ureterocystoneostomy (91 = 85%), pyelo-pyelic anastomosis (15 = 14%) and uretero-ureteral anastomosis (1 = 0.9%). Sixteen cases presented urinary fistula (15%), emphasizing the high percentage of extravasations occurred in the pyelo-pyelic anastomosis (5/15). The resolution of the problem with graft preservation was achieved in 11 cases (68.75%). We encountered 6 ureteral obstructions that resolved favourably in 100% if the cases. Other important complications were: appearance of lymphocele in 8 cases, detection of post-grafting ureteral stenosis in 5 patients, finding asymptomatic vesicoureteral reflux in 16 grafts, and presence of urinary lithiasis in 2 cases. Similarly, we analyzed our series of 16 vascular complications, emphasizing that 15 out of 107 grafts had arterial or venous vascular abnormalities (14.1%), that forced to perform bench surgery in two occasions. Our statistical analysis showed that arterial thrombosis was more frequent than stenosis (8.49% versus 4.71%), and in nearly 80% of the cases (7/9) it happened in grafts concerning more than one arterial vessel, including in this series thrombosis of any of the ramus. The largest loss of grafting were due to this complication, since in 5 out of 9 cases of arterial thrombosis (55.5%) a transplantectomy had to be performed. With regard to venous complications thrombosis is a relatively rare complication, representing in our series less than 1%, usually associated to uncontrollable vascular acute rejection.

[Is it necessary to combine the surgical treatment of kidney adenocarcinoma with ipsilateral adrenalectomy?]. / Es necesario asociar en el tratamiento quirúrgico del adenocarcinoma renal la adrenalectomía ipsilateral?

We analyzed a series of 202 renal adenocarcinomas, 164 of which were submitted to radical nephrectomy. Pathological analyses of 150 adrenal glands revealed ipsilateral adrenal metastasis in 4 cases, 3 of these coexisting with other distant metastases. The primary tumors in these 4 cases were highly undifferentiated and in the advanced local tumor stage; the only case with solitary adrenal metastasis survived 15 months. The present study and data reported in the literature indicate that ipsilateral adrenalectomy should be performed in addition to radical nephrectomy only in renal tumors of the upper pole, those localized at other sites but whose size indicate the possibility of tumor spreading to the adjacent adrenal gland, or when a suspicious mass in the adrenal gland is evidenced by the preliminary workup or during surgery.

[Evaluation of extravesical ureteroneocystostomy in kidney transplantation]. / Evaluación de la ureterocistoneostomía extravesical en el trasplante renal.

The present study evaluates extravesical ureteroneocystostomy, the technique used for reconstruction of the urinary tract in 120 kidney transplants. The urological complications ascribable to this technique were observed in 10% (12/120) and consisted of urinary extravasation (10), and ureteric obstruction (2). The treatment of the foregoing complications, which was successful in 8 cases, is described. The indications and advantages afforded by this technique in renal transplantation are discussed.