Effectiveness and safety of oral anticoagulant therapy in a real-world cohort with atrial fibrillation: The SIESTA-A study protocol.

INTRODUCTION: Oral anticoagulants (OACs) are first-line drugs for stroke prevention in patients with atrial fibrillation (AF). The introduction of new lines of therapy with direct oral anticoagulants (DOACs) has led to a decreased use of vitamin K antagonists (VKAs). Comparative analyses of DOACs in clinical trials are scarce and the comparator has mostly been warfarin. Their impact on health outcomes in observational studies has not always been consistent. The aim of this study is to evaluate the effectiveness and safety of DOACs and VKAs in patients with AF using Real-World Data (RWD). METHODS AND ANALYSIS: Population-based retrospective cohort study using RWD from actual practice. Period: January 2012-December 2020. Inclusion criteria: patients with AF who had not taken OACs in the previous 12 months. Exclusion criteria: <40 years, with severe mitral stenosis, or valvular heart disease or aortic and/or mitral valve procedures. Data source: The Andalusian Population Health Database, Spain. Outcome measures: a) Effectiveness: ischaemic stroke, transient ischaemic attack, systemic and pulmonary embolism, and death; b) Safety: gastrointestinal and intracranial haemorrhaging; Independent variables: age, sex, comorbidities, medication and health resource use, CHA2DS2-VASC, HAS-BLED, and analytical tests. Statistical analysis: crude incidence analysis, survival models, Kaplan-Meier, Cox regression analysis adjusted for possible confounding and paired analysis by propensity score matching.

Assessment of pre and postoperative anxiety in patients undergoing ambulatory oral surgery in primary care.

BACKGROUND: To analyze the pre- and postoperative anxiety level in patients undergoing ambulatory oral surgery (AOS) in a primary healthcare center (PHC). MATERIAL AND METHODS: Prospective and descriptive clinical study on 45 patients who underwent AOS procedures in the dental clinic of a public PHC of Spain between April and September 2015. Anxiety analysis was carried out with pre- and postoperative anxiety-state (STAI-S), anxiety-trait (STAI-T) and dental anxiety (MDAS) questionnaires. A descriptive, inferential and binary logistic regression analysis were performed for the variables age, sex, educational level, previous experience of oral treatment, type of oral surgery, degree of third molar impaction, surgical time, intraoperative complications, postoperative complications, and pain score with a visual analogue scale (VAS). RESULTS: The majority were female (57.8%) with a mean age of 33.5±9.6 years. The most frequent procedure was the lower third molar removal (82.2%). The mean pain score on the VAS was 1.6±1.8. The incidence of complications was low (7.8%). There was a statistically significant association between post- and preoperative anxiety (r=0.56, p<0.001) and a correlation between pain score and postoperative anxiety (Rho= -0.35, p=0.02). The likelihood of postoperative anxiety was related to preoperative anxiety (OR=1.3, p=0.03). CONCLUSIONS: AOS in a PHC is safe and should be more encouraged in the public primary care. The emotional impact on users was relatively low, highlighting that the preoperative anxiety levels were higher than the postoperative ones. Psychological factors related to pre- and postoperative anxiety should be considered in the AOS carried out in PC.

Disfunción eréctil en pacientes intervenidos de cáncer de próstata. Revisión sistemática de la literatura médica / Erectile dysfunction in patients with prostate cancer who have undergone surgery: Systematic review of literature

Objetivo: Evaluar la aparición de la disfunción eréctil en pacientes con cáncer de próstata sometidos a prostatectomía radical (PR) retropúbica, prostatectomía laparoscópica y/o prostatectomía robótica. Material y métodos: Revisión sistemática de la literatura médica mediante búsqueda bibliográfica (2000–2010) en MedLine, Embase, Cochrane Library, Center for Review Dissemination, ECRI y Hayes. Los términos Mesh fueron «Prostatectomy», «Prostatic neoplasm», «Transuretral resection prostate», «Impotence» y los términos libres fueron «erectile dysfunction» y «prostatectomy». Los estudios incluían pacientes con cáncer de próstata intervenidos para la extirpación de la glándula mediante cirugía abierta (retropúbica), laparoscópica o robótica. Resultados: Se seleccionaron diez estudios observacionales de calidad moderada y 29 series de casos de baja calidad. Los estudios observacionales presentaban los menores porcentajes de disfunción eréctil en pacientes intervenidos mediante cirugía robótica (3–51%). La PR retropúbica (36–91%) y la laparoscópica registraban cifras superiores de aparición de impotencia. Los estudios que comparaban intervenciones, cirugía y radioterapia obtenían con las radiaciones menores índices de disfunción sexual (3–72%). En las series de casos, los menores porcentajes de disfunción eréctil acontecieron en pacientes con cirugía robótica (22%), seguido de cirugía laparoscópica (40%) y de PR retropúbica (41,4%). Conclusiones: Los resultados, aunque deben interpretarse con cautela dada la limitada calidad de los estudios, presentan efectos similares en la evaluación de las diferentes técnicas quirúrgicas, observándose que la cirugía robótica registra los menores porcentajes en relación con la aparición de impotencia sexual (AU)

Objective: To assess erectile dysfunction in patients with prostate cancer undergoing surgery by radical prostatectomy, laparoscopic prostatectomy or robotic prostatectomy. Material and methods: Systematic Review of literature based on a search strategy (2000–10) in MedLine, Embase, Cochrane Library, CRD, ECRI, and Hayes. Mesh terms used were 'Prostatectomy', 'Prostatic Neoplasm', 'Transuretral Resection Prostate', 'Impotence' and as free terms 'erectile dysfunction' and 'prostatectomy'. Studies included patients with prostate cancer underwent by prostatectomy radical with open surgery (retropubic), laparoscopic or robotic surgery. Results: Ten observational studies with moderate quality and 29 case series with low quality were selected. Observational studies showed lower percentages of erectile dysfunction after intervention in the patients underwent robotic surgery (3–51%). Radical surgery (36–91%) and laparoscopic surgery showed higher values of impotence. In the studies that compared surgery versus radiotherapy, the results were better for radiotherapy (3–72% erectile dysfunction). In the case series, lower percentages of erectile dysfunction were shown in patients underwent to robotic surgery (22%), the following was for laparoscopic surgery (40%) and open radical prostatectomy (41.4%). Conclusions: This result should be considered with caution because of the low methodological quality of the studies included. However, the different surgical techniques assessed showed similar effects in the two types of studies included and we found that robotic surgery presented lower percentages of sexual impotence (AU)

[Erectile dysfunction in patients with prostate cancer who have undergone surgery: Systematic review of literature]. / Disfunción eréctil en pacientes intervenidos de cáncer de próstata. Revisión sistemática de la literatura médica.

OBJECTIVE: To assess erectile dysfunction in patients with prostate cancer undergoing surgery by radical prostatectomy, laparoscopic prostatectomy or robotic prostatectomy. MATERIAL AND METHODS: Systematic Review of literature based on a search strategy (2000-10) in MedLine, Embase, Cochrane Library, CRD, ECRI, and Hayes. Mesh terms used were Prostatectomy, "Prostatic Neoplasm, Transuretral Resection Prostate, Impotence and as free terms erectile dysfunction and prostatectomy. Studies included patients with prostate cancer underwent by prostatectomy radical with open surgery (retropubic), laparoscopic or robotic surgery. RESULTS: Ten observational studies with moderate quality and 29 case series with low quality were selected. Observational studies showed lower percentages of erectile dysfunction after intervention in the patients underwent robotic surgery (3-51%). Radical surgery (36-91%) and laparoscopic surgery showed higher values of impotence. In the studies that compared surgery versus radiotherapy, the results were better for radiotherapy (3-72% erectile dysfunction). In the case series, lower percentages of erectile dysfunction were shown in patients underwent to robotic surgery (22%), the following was for laparoscopic surgery (40%) and open radical prostatectomy (41.4%). CONCLUSIONS: This result should be considered with caution because of the low methodological quality of the studies included. However, the different surgical techniques assessed showed similar effects in the two types of studies included and we found that robotic surgery presented lower percentages of sexual impotence.