Discrimination of glaucomatous from non-glaucomatous optic neuropathy with swept-source optical coherence tomography.

OBJECTIVE: To assess the ability of optic nerve head (ONH) parameters, peripapillary retinal nerve fiber layer (pRNFL), and macular ganglion cell layer (GCL) thickness measurements with swept-source optical coherence tomography (SS-OCT), to discriminate between glaucomatous and non-glaucomatous optic neuropathy (GON and NGON). METHODS: This retrospective cross-sectional study involved 189 eyes of 189 patients, 133 with GON and 56 with NGON. The NGON group included ischemic optic neuropathy, previous optic neuritis, and compressive, toxic-nutritional, and traumatic optic neuropathy. Bivariate analyses of SS-OCT pRNFL and GCL thickness and ONH parameters were performed. Multivariable logistic regression analysis was employed to obtain predictor variables from OCT values, and the area under the receiver operating characteristic curve (AUROC) was calculated to differentiate between NGON and GON. RESULTS: Bivariate analyses showed that the overall and inferior quadrant of the pNRFL was thinner in the GON group (P=0.044 and P<0.01), while patients with NGON had thinner temporal quadrants (P=0.044). Significant differences between the GON and NGON groups were identified in almost all the ONH topographic parameters. Patients with NGON had thinner superior GCL (P=0.015), but there were no significant differences in GCL overall and inferior thickness. Multivariate logistic regression analysis demonstrated that vertical cup-to-disc ratio (CDR), cup volume, and superior GCL provided independent predictive value for differentiating GON from NGON. The predictive model of these variables along with disc area and age achieved an AUROC=0.944 (95% CI 0.898-0.991). CONCLUSIONS: SS-OCT is useful in discriminating GON from NGON. Vertical CDR, cup volume, and superior GCL thickness show the highest predictive value.

Cardiovascular research and population-based prospective cohort studies: as time goes by

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Resultados en salud tras la implantación de una guía multidisciplinar para la atención a la fractura de cadera / Health outcomes after the implementation of multidisciplinary clinical guidelines for the care of hip fractures

Antecedentes y objetivo: Evaluar el impacto de la aplicación de una guía clínica multidisciplinar en el proceso de atención a pacientes con fractura de cadera. Material y métodos: Estudio prospectivo pre y postintervención en una Unidad de Ortogeriatría de un hospital de segundo nivel tras implementar una guía clínica multidisciplinar de atención a la fractura de cadera. Se analizan las características basales de los pacientes y las variaciones observadas en las variables de proceso y de desenlace en los 2períodos estudiados (junio del 2015-mayo del 2016 y junio del 2016-mayo del 2017). Resultados: Las características basales de la población fueron similares en el período preintervención (n = 455) y en el período postintervención (n = 456). La edad media de los pacientes fue 84,8 ± 6,8 años y un 70,8% eran mujeres. La aplicación de la guía clínica multidisciplinar produjo una reducción de la estancia media (16,9 días vs. 15,6 días, p = 0,014) y mejoró la prescripción del tratamiento de la osteoporosis (51,6% vs. 88%, p < 0,001), y redujo los episodios de delirio (44% vs. 31,2%, p < 0,001), broncoespasmo (18,3% vs. 12%, p = 0,019), insuficiencia cardíaca (20% vs. 11,5%, p < 0,001) y enfermedad pulmonar obstructiva crónica agudizada (7,9% vs. 3,8%, p = 0,017). Observamos un incremento de las úlceras por presión al alta (2,9% vs. 9%, p = 0,001). No hubo diferencias en la proporción de pacientes operados en menos de 48 h (56% vs. 61,2%, p = 0,64), en reingresos hospitalarios (6,9% vs. 5,9%, p = 0,51) ni en mortalidad (5,0% vs. 7,2%, p = 0,17). Conclusiones: La implantación de una guía clínica multidisciplinar mejoró aspectos del proceso de atención a los pacientes con fractura de cadera (AU)

Background and objectives: This study aims to evaluate the impact of implementing multidisciplinary clinical guidelines in the process of caring for patients with hip fractures. Materials and methods: This work is a pre- and post-intervention prospective study in the Orthogeriatrics Unit of a second-level hospital after implementing multidisciplinary clinical guidelines for hip fracture care. We analyzed patients’ baseline characteristics and the variations observed in care provided and in outcome variables in the 2periods studied (June 2015-May 2016 and June 2016-May 2017). Results: The baseline characteristics of the population were similar in the pre-intervention period (n=455) compared to the post-intervention period (n=456). Patients’ mean age was 84.8 ± 6.8 years and 70.8% were women. The implementation of the multidisciplinary clinical guidelines led to a reduction in the mean length of hospital stay (16.9 days vs 15.6 days, p=.014); improved osteoporosis treatment prescribing (51.6% vs 88%, p<.001); and reduced episodes of delirium (44% vs 31.2%, p<.001), bronchospasm (18.3% vs 12%, p=.019), heart failure (20% vs 11.5%, p<.001), and COPD exacerbation (7.9% vs 3.8%, p=.017). We observed an increase in pressure ulcers at discharge (2.9 vs 9%, p<.001). There were no differences in the percentage of operations in less than 48hours (56% vs 61.2% p=.64), hospital readmissions (6.9% vs 5.9%, p=.51), or mortality (5.0% vs 7.2%, p=.17). Conclusions:The implementation of multidisciplinary clinical guidelines improved aspects of the care process for patients with hip fracture (AU)

Health outcomes after the implementation of multidisciplinary clinical guidelines for the care of hip fractures.

BACKGROUND AND OBJECTIVES: This study aims to evaluate the impact of implementing multidisciplinary clinical guidelines in the process of caring for patients with hip fractures. MATERIALS AND METHODS: This work is a pre- and post-intervention prospective study in the Orthogeriatrics Unit of a second-level hospital after implementing multidisciplinary clinical guidelines for hip fracture care. We analyzed patients' baseline characteristics and the variations observed in care provided and in outcome variables in the two periods studied (June 2015-May 2016 and June 2016-May 2017). RESULTS: The baseline characteristics of the population were similar in the pre-intervention period (n = 455) compared to the post-intervention period (n = 456). Patients' mean age was 84.8 ± 6.8 years and 70.8% were women. The implementation of the multidisciplinary clinical guidelines led to a reduction in the mean length of hospital stay (16.9 days vs. 15.6 days, p= .014); improved osteoporosis treatment prescribing (51.6% vs. 88%, p< .001); and reduced episodes of delirium (44% vs. 31.2%, p < .001), bronchospasm (18.3% vs. 12%, p = .019), heart failure (20% vs. 11.5%, p < .001), and COPD exacerbation (7.9% vs. 3.8%, P = .017). We observed an increase in pressure ulcers at discharge (2.9 vs. 9%, P < .001). There were no differences in the percentage of operations in less than 48 h (56% vs. 61.2% p = .64), hospital readmissions (6.9% vs. 5.9%, p = .51), or mortality (5.0% vs. 7.2%, p = .17). CONCLUSIONS: The implementation of multidisciplinary clinical guidelines improved aspects of the care process for patients with hip fracture.

Colorectal anastomosis during cytoreductive radical surgery in patients with peritoneal surface malignancies. Validation of a new technique (without stoma) to prevent anastomosis leakage in more than 1000 procedures

Objective To describe a novel end-to-end “true” reinforced stapling colorectal anastomosis and to assess surgical outcomes in a large case series of advanced cancer patients undergoing this procedure. Summary background data Anastomotic leakage (AL) remains the main concern following surgery for colorectal cancer. Methods Between September 2006 and May 2018, in the context of the Catalonian Program of Peritoneal Carcinomatosis, 1193 consecutive patients with advanced abdominal and/or pelvic tumors were included in a prospective single-center study. They underwent cytoreductive radical surgery (CRS) in most cases combined with hyperthermic intraperitoneal chemotherapy (HIPEC). Among other surgical procedures, 374 patients underwent rectal resection and colorectal/ileorectal anastomosis, whether alone or associated to other digestive anastomosis. Key aspects of colorectal anastomosis technique were: (1) complete dissection and mobilization of the distal third of the rectum, (2) placement of a stitch that included both ends of the linear stapling of the rectal stump that was knotted on the anvil of the circular stapler, (3) “cleaning” the fatty tissue of the intestinal ends, (4) adjustment of the height of staples to the thickness of the intestinal wall, and (5) a second layer of interrupted nonperforating sutures placed circumferentially to reinforce the stapled anastomoses. A diverting stoma was not performed. Results According to clinical criteria, of the 1193 patients included, 296 cases underwent CRS (group 1) and 897 cases CRS + HIPEC (group 2). In group 1, 332 surgical procedures were performed, with 248 digestive anastomoses, of which 98 (39.5%) were colorectal anastomoses, associated to other digestive anastomosis in 37 cases (AU)

Colorectal anastomosis during cytoreductive radical surgery in patients with peritoneal surface malignancies. Validation of a new technique (without stoma) to prevent anastomosis leakage in more than 1000 procedures.

OBJECTIVE: To describe a novel end-to-end "true" reinforced stapling colorectal anastomosis and to assess surgical outcomes in a large case series of advanced cancer patients undergoing this procedure. Anastomotic leakage (AL) remains the main concern following surgery for colorectal cancer. METHODS: Between September 2006 and May 2018, in the context of the Catalonian Program of Peritoneal Carcinomatosis, 1193 consecutive patients with advanced abdominal and/or pelvic tumors were included in a prospective single-center study. They underwent cytoreductive radical surgery (CRS) in most cases combined with hyperthermic intraperitoneal chemotherapy (HIPEC). Among other surgical procedures, 374 patients underwent rectal resection and colorectal/ileorectal anastomosis, whether alone or associated to other digestive anastomosis. Key aspects of colorectal anastomosis technique were: (1) complete dissection and mobilization of the distal third of the rectum, (2) placement of a stitch that included both ends of the linear stapling of the rectal stump that was knotted on the anvil of the circular stapler, (3) "cleaning" the fatty tissue of the intestinal ends, (4) adjustment of the height of staples to the thickness of the intestinal wall, and (5) a second layer of interrupted nonperforating sutures placed circumferentially to reinforce the stapled anastomoses. A diverting stoma was not performed. RESULTS: According to clinical criteria, of the 1193 patients included, 296 cases underwent CRS (group 1) and 897 cases CRS + HIPEC (group 2). In group 1, 332 surgical procedures were performed, with 248 digestive anastomoses, of which 98 (39.5%) were colorectal anastomoses, associated to other digestive anastomosis in 37 cases. In group 2, 972 surgical procedures were performed, with 707 digestive anastomoses, of which 263 were colorectal (37.2%), 116 were associated with other digestive anastomosis. Ileocolic anastomosis was the most frequently associated digestive anastomosis. 71 major urinary reconstructions, 283 radical hysterectomies and no diverting stoma were performed. Globally, there was only three colo-ileorectal AL (3/374 = 0.8%). The overall 90-day mortality rate was 0.25%. CONCLUSIONS: A technical modification to create a "true" end-to-end and completely circular reinforced anastomosis effectively prevents anastomotic leakage in patients with advanced tumors undergoing radical resection of the rectum, with no need of diverting stoma.

Relación entre síndrome de disfunción temporomandibular y síndrome de latigazo cervical tras un accidente de tráfico. Estudio de cohortes / Relationship between temporomandibular disorders and whiplash after a traffic accident. Cohorts study

Introducción: El síndrome de latigazo cervical (SLC) es una patología frecuente, y según la bibliografía existe controversia acerca de una relación entre este y el síndrome de disfunción temporomandibular (SDT). El objetivo de este estudio es determinar si existe una mayor incidencia de SDT en pacientes diagnosticados de SLC durante los 3 y 12 primeros meses tras haber sufrido un accidente de tráfico y determinar factores de riesgo asociados. Pacientes y método: Estudio de cohortes prospectivo comprendido entre febrero del 2013 a diciembre del 2015 que consta de una cohorte expuesta de 71 adultos (36 hombres y 35 mujeres) que habían sufrido un SLC de grado I o II según la Québec Task Force, y una cohorte no expuesta de 70 adultos (46 hombres y 24 mujeres). Se avaluaron a los 3 y 12 meses mediante el Índice Anamnésico Simplificado de Fonseca (IASF) Resultados: Los resultados obtenidos muestran que en la cohorte expuesta la proporción de SDT a los 3 meses es estadísticamente superior que en la cohorte no expuesta (53 versus 13,4%; p<0,0001). A los 12 meses se evidencia que en la cohorte expuesta la proporción de SDT es estadísticamente superior que en la cohorte no expuesta (53,2 versus 21,7%; p<0,0005). Conclusiones: Las personas que sufren un SLC presentan una mayor probabilidad de desarrollar un SDT. Además, la cohorte expuesta muestra un empeoramiento en las puntuaciones del IASF. Aquellas personas que manifiestan dorsalgia y parestesias tras sufrir un SLC presentan una mayor probabilidad estadísticamente significativa de desarrollar un SDT

Introduction: Whiplash is a frequent condition in rehabilitation centres, and according to the literature there is a great controversy about its relationship with temporomandibular disorders (TD). The objective of this study is to determine whether there is a higher incidence of TD in patients diagnosed with whiplash during the first 3 and 12 months after having suffered a vehicle accident, and to determine associated risk factors. Patients and method: Prospective cohort study conducted between February 2013 to December 2015 with a cohort of 71 adults (36 men and 35 women) that had suffered a Quebec Task Force whiplash grade I or II, together with an unexposed cohort of 70 adults (46 men and 24 women). They were evaluated at 3 and 12 months using the Fonseca's Simplified Anamnestic Index (IASF) Results: The results obtained at 3 months showed that the proportion of TD in the exposed cohort was statistically higher than in the non-exposed cohort (53.0% versus 13.4%, P<.0001). At 12 months, the results showed that the proportion of SDT was statistically higher in the exposed cohort than in the non-exposed cohort (53.2% versus 21.7%, P<.0005). Conclusions: After a whiplash there is a greater probability of developing a TD. In addition, in the exposed cohort there is a greater deterioration over time in the IASF. The back pain and paraesthesias after a whiplash are symptoms to be taken into account, as they show a statistically significant probability of developing TD

Prevalence of Abdominal Aortic Aneurysm in Men Aged 65-74 Years in a Metropolitan Area in North-East Spain.

BACKGROUND: A declining prevalence of AAA and a shift in the distribution towards the older population have been observed during the last decade in Europe. The aim was to estimate the current screening prevalence of AAA in men aged 65-74 years in a metropolitan area in north-east Spain and to identify associated risk factors. METHODS: A cross sectional prevalence study in men registered in L'Hospitalet Primary Healthcare Services (Barcelona, Spain) was performed. There were 619 randomly selected subjects (expected prevalence of aneurysm, 5%; accuracy of estimation, ±2%; loss to follow up, 30%). Exclusion criteria were life expectancy <1 year, limited quality of life, previous diagnosis of AAA, prior aorto-femoral surgery, and non-Caucasian. The following were measured: internal diameter of the infrarenal abdominal aorta using ultrasound, cardiovascular risk factors, personal (heart disease, stroke, peripheral vascular disease) and family history (AAA), physical examination, and blood tests. We estimated the prevalence and 95% confidence interval of AAA, and used logistic regression analysis to identify risk factors for AAA. RESULTS: Among the 651 individuals included in the analysis the prevalence of aneurysm was 2.30% (95% CI, 1.30-3.77%). In the regression analysis, AAA was associated with smoking (0-10, 11-20, or >20 cigarettes/day), diagnosis of myocardial infarction, and being taller than the median (165 cm). CONCLUSIONS: The current screening prevalence of AAA among men aged 65-74 years in a metropolitan area in north-east Spain is similar to that in northern Europe. Smoking, myocardial infarction, and height were associated with the presence of AAA.

Resultados en la calidad de vida y la severidad de la incontinencia urinaria tras rehabilitación en varones prostatectomizados por neoplasia de próstata / Results of rehabilitation on quality of life and urinary incontinence severity after radical prostatectomy

Introducción. La incontinencia urinaria en varones tras prostatectomía radical puede suponer un problema importante de calidad de vida. El tratamiento rehabilitador disminuye las pérdidas urinarias y el empleo de protectores, mejorando así la calidad de vida de estos pacientes. Material y métodos. Se evaluó una cohorte de 84 varones tras cirugía radical de próstata. Todos los pacientes presentaban incontinencia urinaria secundaria a la cirugía y 71 pacientes completaron el tratamiento rehabilitador. La media de edad de los pacientes fue de 64 años. El tiempo medio de sondaje vesical postoperatorio fue de 23,4 días. Se analizaron los resultados obtenidos en las escalas de Sandvik e ICIQ y la cantidad de protectores empleados antes y después del tratamiento. Los pacientes realizaron una media de 12,7 sesiones de rehabilitación. Resultados. Se analizaron las diferencias obtenidas en ambas escalas y en el empleo de protectores y su correlación mediante el test de Wilcoxon y el coeficiente de Spearman. Se observó una mejoría estadísticamente significativa en los resultados obtenidos en las escalas de valoración antes y después del tratamiento rehabilitador (p < 0,0005); los porcentajes de cambio en los resultados obtenidos en dichas escalas se correlacionaron de forma estadísticamente significativa con la disminución en el empleo de protectores al finalizar el tratamiento. Conclusión. El tratamiento rehabilitador es útil para mejorar la calidad de vida y disminuir la severidad de la incontinencia urinaria en pacientes sometidos a cirugía radical de próstata (AU)

Introduction. Male urinary incontinence after radical prostatectomy can substantially impair quality of life. Rehabilitation is used to reduce urinary leakage and the use of pads and diapers, and consequently to improve quality of life. Material and methods. A total of 84 patients were evaluated after radical prostatectomy. All of them had postoperative urinary incontinence and 71 completed rehabilitation treatment. The mean age was 64 years. The mean length of bladder catheterization after surgery was 23.4 days. The results of the Sandvik and International Consultation on Incontinence Questionnaire scales and pad use were analyzed before and after rehabilitation treatment. The mean length of rehabilitation treatment was 12.7 days. Results. The Wilcoxon and Spearman tests showed a significant pos-treatment improvement in both scales (p < .0005). This improvement was significantly correlated with a decrease in pad use at the end of the treatment. Conclusion. Rehabilitation treatment is useful to improve quality of life and decrease the severity of urinary incontinence in men after radical prostatectomy (AU)

Predictores electrocardiográficos y ecocardiográficos de fibrilación auricular en pacientes hipertensos / Electrocardiographic and echocardiographic predictors of atrial fibrillation in hypertensive patients

Introducción y objetivo La aparición de fibrilación auricular en pacientes hipertensos se asocia a una alta incidencia de complicaciones cardiovasculares. Se evalúan los parámetros clínicos, electrocardiográficos y ecocardiográficos predictores de fibrilación auricular en pacientes hipertensos. Pacientes y métodos Se analizó retrospectivamente a 183 pacientes hipertensos sin historia de fibrilación auricular atendidos en la Consulta de Hipertensión. Resultados Después de un seguimiento medio de 4±2,2 años, 23 pacientes (12,5%) presentaron fibrilación auricular. Los pacientes con fibrilación auricular durante el seguimiento presentaron mayor edad (74,6 vs 62,7 años; p<0,0005), mayor tasa de obesidad (60,8 vs 38,5%; p=0,049), mayor tasa de enfermedad cardiovascular establecida (52 vs 28%; p=0,025), menor tasa de pacientes dipper (41 vs 59%; p=0,014), mayor tamaño de aurícula izquierda (48,7 vs 38,2mm; p<0,0005), mayor masa de ventrículo izquierdo (324 vs 266g; p=0,014), menor fracción de eyección (62,6 vs 69,7%; p=0,002), mayor tasa de insuficiencia mitral (82 vs 51,7%; p=0,008), una mayor tasa de pacientes con criterios de hipertrofia ventricular izquierda (21,7 vs 7,4%; p=0,026) y mayor presencia de extrasistolia supraventricular (23,5 vs 6,1%; p=0,044). No hubo diferencias en ningún otro parámetro electrocardiográfico analizado: duración, amplitud, dispersión y eje de la onda P; intervalo PR; duración QRS y frecuencia cardiaca basal. Únicamente la edad (OR 1,06) y la dilatación de AI (OR 1,22) fueron factores significativos predictores independientes en al análisis multivariado. Conclusión En nuestra población de pacientes hipertensos, la edad y el diámetro de la AI son factores predictores para la aparición de fibrilación auricular (AU)

Introduction and objective Appearance of atrial fibrillation in hypertensive patients is associated with a high incidence of cardiovascular complications. Clinical, electrocardiographic and echocardiographic parameters, predictors of atrial fibrillation in hypertensive patients, have been evaluated. Patients and methods A total of 183 hypertensive patients with no history of atrial fibrillation who were seen in the Hypertension Medical Office were analyzed retrospectively. Results After a mean follow-up of 4±2.2 years, 23 patients (12.5%) developed atrial fibrillation. Patients with atrial fibrillation during follow-up were older (74.6 years vs. 62.7 years, p<.0005), had a higher rate of obesity (60.8% vs 38.5%, p=.049), higher rate of established cardiovascular disease (52% vs 28%, p=.025), lower rate of dipper patients (41% vs 59%, p=.014), larger left atrium (48.7mm vs 38.2mm, p<.0005), larger left ventricular mass (324g vs 266g, p=.014), lower ejection fraction (62.6% vs 69.7%, p=.002), higher rate of mitral insufficiency (82% vs 51.7%, p=.008), higher rate of patients with left ventricular hypertrophy criteria (21.7% vs 7.4%, p=.026), and greater presence of supraventricular extrasystoles (23.5% vs 6.1%, p=.044). There were no differences in any of the other electrocardiographic parameter analyzed, that is in duration, amplitude, dispersion and P wave axis, PR interval, QRS duration and baseline heart rate. Only age (OR 1.06) and dilated LA (OR 1.22) were independent significant predictors in the multivariate analysis. ConclusionIn our population of hypertensive patients, age and left atrium diameter are predictors of the onset of atrial fibrillation (AU)

Trastornos del control de los impulsos y punding en la enfermedad de Parkinson: la necesidad de una entrevista estructurada / Impulse control disorders and punding in Parkinson’s disease: the need for a structured interview

Introducción: Los trastornos del control de impulsos (TCI) que incluyen hipersexualidad, ludopatía, compulsión por comer, comprar y consumir fármacos dopaminérgicos, han sido descritos en la enfermedad de Parkinson (EP) así como el punding (comportamiento estereotipado que comprende rituales motores automáticos, sin finalidad). Dado que los pacientes no suelen referir a su neurólogo estas conductas, el TCI y el punding están infradiagnosticados en la práctica clínica. Método: Prospectivamente a 216 pacientes consecutivos (102 hombres, edad media 77±5 años) con EP idiopática se les preguntó sistemáticamente sobre síntomas relacionados con TCI y punding. Además, se obtuvo una muestra al azar apareada por edad y sexo, de 216 pacientes con EP idiopática, y se revisó retrospectivamente la presencia de síntomas relacionados con TCI y punding que habían sido referidos espontáneamente. Resultados: Veinte casos (9,26%) de 216 pacientes con EP que contestaron el cuestionario de forma prospectiva presentaron TCI y/o punding, algunos de ellos con más de un tipo de conducta repetitiva: 7 hipersexualidad (3,24%), 2 ludopatía (0,93%), 4 compra compulsiva (1,85%), 2 atracones (0,93%), 8 punding (3,70%) y uno abuso de medicación (0,46%). De la muestra retrospectiva de 216 pacientes apareados por edad y sexo, sólo 5 pacientes (2,31%) habían referido de forma espontánea estos síntomas: 2 hipersexualidad (0,93%), 2 juego patológico (0,93%) y uno punding (0,46%). Conclusiones: Los pacientes con EP no admiten espontáneamente la presencia de TCI y punding, por lo que estas conductas están infradiagnosticadas .Para garantizar su detección es necesaria la realización de una entrevista dirigida (AU)

Introduction: Impulse control disorders (ICD) including hypersexuality, compulsive gambling, buying, eating, shopping and dopaminergic medication use, have been reported to occurfrequently in Parkinson’s disease (PD). Punding (complex, repetitive, excessive, non-goal oriented behaviours) have also been described. As patients may not report such behaviours to their neurologist, ICD and punding appear to be under-recognised in clinicalpractice. Method: We Prospectively screened 216 consecutive patients (102 men, age 77±5 years)with idiopathic PD. Patients and their caregivers were encouraged to complete a questionnairewith six questions on symptoms related to ICD and punding. In addition, weobtained a random sample matched by age and sex of 216 patients with idiopathic PD, and retrospective analysis of symptoms related to ICD and punding who had been referred spontaneously.Results: Only 20 cases (9.26%) of 216 patients with PD who answered the questionnaire prospectively presented ICD and / or punding, some involving more than one type of repetitivebehaviour and reward-seeking: 7 hypersexuality (3.24%), 2 p athological gambling (0.93%), 4 compulsive buying (1.85%), 2 compulsive eating (0.93%), 8 punding (3.70%) and 1 abuse ofmedication (0.46%).Of the retrospective sample of 216 patients age- and gender-matched, only5 patients (2,31%) had spontaneously mentioned these symptoms: 2 hypersexuality (0.93%), 2pathological gambling (0.93%) and 1 punding (0.46%). Conclusions: Patients with PD do not spontaneously admit the presence of ICD or punding andthese behaviours appear to be under-recognised in clinical practice. A screening questionnaire is needed to ensure their detection (AU)

Impulse control disorders and punding in Parkinson's disease: the need for a structured interview.

INTRODUCTION: Impulse control disorders (ICD) including hypersexuality, compulsive gambling, buying, eating, shopping and dopaminergic medication use, have been reported to occur frequently in Parkinson's disease (PD). Punding (complex, repetitive, excessive, non-goal oriented behaviours) have also been described. As patients may not report such behaviours to their neurologist, ICD and punding appear to be under-recognised in clinical practice. METHOD: We Prospectively screened 216 consecutive patients (102 men, age 77±5 years) with idiopathic PD. Patients and their caregivers were encouraged to complete a questionnaire with six questions on symptoms related to ICD and punding. In addition, we obtained a random sample matched by age and sex of 216 patients with idiopathic PD, and retrospective analysis of symptoms related to ICD and punding who had been referred spontaneously. RESULTS: Only 20 cases (9.26%) of 216 patients with PD who answered the questionnaire prospectively presented ICD and / or punding, some involving more than one type of repetitive behaviour and reward-seeking: 7 hypersexuality (3.24%), 2 pathological gambling (0.93%), 4 compulsive buying (1.85%), 2 compulsive eating (0.93%), 8 punding (3.70%) and 1 abuse of medication (0.46%).Of the retrospective sample of 216 patients age- and gender-matched, only 5 patients (2,31%) had spontaneously mentioned these symptoms: 2 hypersexuality (0.93%), 2 pathological gambling (0.93%) and 1 punding (0.46%). CONCLUSIONS: Patients with PD do not spontaneously admit the presence of ICD or punding and these behaviours appear to be under-recognised in clinical practice. A screening questionnaire is needed to ensure their detection.

Disminución del dolor y el peso durante el tratamiento de fisioterapia en pacientes intervenidos de prótesis de rodilla / Decrease in pain and weight loss during physiotherapy treatment in patients operated on for knee prosthesis

El dolor de los pacientes recién intervenidos de prótesis total de rodilla es el principal problema durante la primera fase de fisioterapia, la cual es más rápida y eficiente en pacientes sin sobrepeso. Se realizó un ensayo clínico aleatorio con el fin de demostrar la disminución del dolor y el peso corporal en pacientes obesos intervenidos de prótesis de rodilla mediante la aplicación de un biorritmo fisiológico diario y protocolizado de nutrición, ejercicio físico, hidratación y descanso en los dos meses posteriores a la operación. Al grupo control (19 pacientes) se le aplicó un tratamiento de fisioterapia tras la operación de artroplastia de rodilla, y al grupo de intervención (19 pacientes) además se le aplicó el protocolo. En ambos grupos se efectuaron tres mediciones: recién intervenidos, al mes y a los dos meses. Se observó homogeneidad basal entre ambos grupos en todas las variables recogidas: edad, sexo, índice de masa corporal (IMC), peso y dolor medido mediante escala de valoración analógica (EVA). Se demostraron diferencias significativas en el peso, el IMC y el dolor comparando ambos grupos (p<0,0005). En el grupo de intervención, a los dos meses de la operación los pacientes pesaron 4,5kg menos y el dolor desapareció. En cuanto al grupo control, el peso no varió y el dolor fue de 3 en la EVA. En conclusión, este estudio muestra que un protocolo de ritmo de vida fisiológico de ayuda al tratamiento básico de fisioterapia aplicado en pacientes con sobrepeso recién intervenidos de prótesis de rodilla ocasionaron mejoras significativas en el dolor y la disminución de peso (AU)

Pain of recently operated patients for total knee prosthesis is the main problem during the first phase of physiotherapy, which is faster and more efficient in non-overweight patients. We performed a randomized clinical trial to demonstrate pain and body weight reduction in obese patients undergoing knee prosthesis through daily biorhythms and physiological protocolized nutrition, exercise, hydration and rest during the two months post-operation. The methodology was to compare two groups of 19 patients each. One control group only received physical therapy after knee arthroplasty operation and the protocol was also applied in the second group. Three measurements were performed for each group: at recently intervened, at one month and at two months. Baseline homogeneity was observed between both groups in all of the variables collected: age, sex, body mass index (BMI), weight, measured by pain analogue assessment scale (ASA). Significant differences were demonstrated in weight, BMI and pain when both groups were compared (p<0.0005). At two months of the operation, the interventions weights 4.5kg less and the paid had disappeared. In regards to the control group, their weight did not vary and pain was 3 on the ASA. In conclusion, this study has shown that a physiological life rhythm protocol in combination with basic physiotherapy treatment applied in recently operations overweight patients of knee prosthesis leads to significant improvements in pain and weight loss (AU)

Indicadores de hipertensión de bata blanca diagnosticada mediante automedida de la presión arterial domiciliaria / White-coat hypertension indicators diagnosed through self-measurement of blood pressure at home

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[Home blood pressure self-monitoring. Influence of the mean calculation used on the diagnosis of white-coat hypertension]. / Automedida de la presión arterial domiciliaria. Influencia del sistema de cálculo de la media en el diagnóstico de la hipertensión de bata blanca.

OBJECTIVE: To describe the variations in the diagnosis performance of home blood pressure self-monitoring (hBPSM) with different methods for mean calculation, in order to diagnose white-coat hypertension (WCH). DESIGN: Multi-centre, descriptive, and comparative study to assess the diagnosis performance of a test method. SETTING: Four primary health care centres. PARTICIPANTS: A total of 157 recently-diagnosed, untreated patients with mild-moderate hypertension took part in the study. METHODS: The results obtained with hBPSM (3 consecutive days with readings in triplicate, morning-night) were compared with a "gold standard" out-patient blood pressure reading (OutBP). RESULTS: Systolic and diastolic BP values of the first day and first reading (morning-night) were higher than the remaining days and readings (linear trend P< .001). Results in hBPSM diagnostic performance using all readings to calculate the mean were: sensitivity (S), 47.6%; specificity (Sp), 77.4%; positive and negative predictive values (PPV and NPV), 58.8% and 68.6%, with positive and negative probability coefficients (PPC and NPC), 2.10 and 0.67. When readings with greater patient alarm reaction (first day and first reading, morning-night) were removed, greater values of S (61.9%) were obtained, albeit at expense of an excessive loss in Sp (64.5%) and without improvement in PPC (1.74). CONCLUSIONS: The diagnostic performance of hBPSM in WCH was low and failed to improve with the use of different systems to calculate mean BP.

Automedida de la presión arterial domiciliaria. Influencia del sistema de cálculo de la media en el diagnóstico de la hipertensión de bata blanca / Home blood pressure self-monitoring. Influence of the mean calculation used on the diagnosis of white-coat hypertension

Objetivo. Describir las variaciones que se producen en el rendimiento de la automedida de la presión arterial domiciliaria (AMPAd) al emplear diferentes sistemas para calcular la media, en el diagnóstico de la hipertensión de bata blanca (HBB). Diseño. Estudio multicéntrico, descriptivo y comparativo para evaluar el rendimiento diagnóstico de una prueba. Emplazamiento. Cuatro centros de atención primaria. Participantes. Se seleccionó a 157 pacientes con hipertensión leve-moderada, recién diagnosticados y sin tratamiento farmacológico, que presentaron las 18 lecturas de AMPAd. Métodos. A cada paciente se le realizó una AMPAd (3 días consecutivos con lecturas por triplicado mañana-noche) y una monitorización ambulatoria de la presión arterial (MAPA) empleado, como prueba de referencia. Resultados. Los valores de presión arterial sistólica y diastólica del primer día y de la primera lectura (mañana-noche) eran mayores que los restantes días y lecturas (tendencia lineal p < 0,001). Al emplear todas las lecturas para calcular la media los parámetros de rendimiento diagnóstico obtenidos fueron: sensibilidad (S) 47,6%, especificidad (E) 77,4%, valores predictivos positivo y negativo 58,8 y 68,6%, coeficientes de probabilidad positivo y negativo (CPP y CPN) 2,10 y 0,67, respectivamente. Al eliminar las lecturas con mayor reacción de alerta (primer día y primera lectura mañana-noche) se incrementaba la S (61,9%) a expensas de un descenso excesivo de la E (64,5%), sin que mejorara el CPP (1,74). Conclusiones. La AMPAd en el diagnóstico de la HBB obtiene un bajo rendimiento que no mejora con el empleo de diferentes sistemas para calcular la media de presión arterial

Objective. To describe the variations in the diagnosis performance of home blood pressure self-monitoring (hBPSM) with different methods for mean calculation, in order to diagnose white-coat hypertension (WCH). Design. Multi-centre, descriptive, and comparative study to assess the diagnosis performance of a test method. Setting. Four primary health care centres. Participants. A total of 157 recently-diagnosed, untreated patients with mild-moderate hypertension took part in the study. Methods. The results obtained with hBPSM (3 consecutive days with readings in triplicate, morning-night) were compared with a "gold standard" out-patient blood pressure reading (OutBP). Results. Systolic and diastolic BP values of the first day and first reading (morning-night) were higher than the remaining days and readings (linear trend P<.001). Results in hBPSM diagnostic performance using all readings to calculate the mean were: sensitivity (S), 47.6%; specificity (Sp), 77.4%; positive and negative predictive values (PPV and NPV), 58.8% and 68.6%, with positive and negative probability coefficients (PPC and NPC), 2.10 and 0.67. When readings with greater patient alarm reaction (first day and first reading, morning-night) were removed, greater values of S (61.9%) were obtained, albeit at expense of an excessive loss in Sp (64.5%) and without improvement in PPC (1.74). Conclusions. The diagnostic performance of hBPSM in WCH was low and failed to improve with the use of different systems to calculate mean BP

Automatic detection of patients with nosocomial infection by a computer-based surveillance system: a validation study in a general hospital.

OBJECTIVE: To validate an automated system for the detection of patients with nosocomial infection (NI) in an intensive care unit (ICU). DESIGN: Retrospective analysis of data from the hospital information system. We applied 3 different NI suspicion criteria (positive microbiology reports, antibiotic administration, and diagnosis of clinical infection) and compared the results to those of a prospective NI incidence study done in the ICU during the same period (1999-2002). SETTING: A 250-bed general hospital in Barcelona, Spain. PATIENTS: From April 15, 1999, through June 30, 2002, 1380 patients were admitted to the ICU. Of these, 1043 had an ICU stay of more than 24 hours and were included in the study. RESULTS: At least one NI suspicion criterion was present for 242 patients (23.2%); 2 criteria were present for 184 patients (17.6%); and all 3 criteria were present for 112 (11.7%). Comparison of hospital information system data to the results of the prospective study indicated that the combination of 2 criteria demonstrated the most satisfactory sensitivity (94.3%; 95% confidence interval [CI], 79.5%-99.0%) and specificity (83.6%; 95% CI, 76.8%-88.9%). The positive predictive value was 55.9% (95% CI, 42.5%-68.6%); the negative predictive value was 98.5% (95% CI, 94.2%-99.7%). The system could assign a site of infection for 90.4% of the NIs detected. CONCLUSION: The hospital information system was a useful tool for retrospectively detecting patients with an NI during the ICU stay. Given its high sensitivity, it may be useful as an alert for the NI team.

[Effectiveness of self-monitoring of blood pressure in white coat hypertension diagnosis. Rationale and design]. / Efectividad de la automedida de la presión arterial en el diagnóstico de la hipertensión clínica aislada. Justificación y diseño del estudio.

OBJECTIVE: To assess the effectiveness of blood pressure self-monitoring at home in front of 24-h blood pressure ambulatory measurement in isolated clinical hypertension diagnosis. DESIGN: Comparative study of repeated measurements of self-monitoring home BP and 24-h ambulatory BP measurement in a hypertensive patients sample. SETTING AND SUBJECTS TO STUDY: Mild-moderate essential hypertensive patients newly diagnosed or previously diagnosed in which suspect isolated clinical hypertension (BP>140/90 mm Hg in clinical setting repeatedly). It needs a sample of 182 hypertensive patients seen at urban primary health care. PRINCIPAL MEASUREMENTS: We compute the isolated clinical hypertension prevalence, the sensibility, specificity and positive and negative predictive values, with 95% confidence intervals. DISCUSSION: Prove the effectiveness of blood pressure self-monitoring at home in insolated clinical hypertension diagnosis, can involve an important cost saving for health care system as in hypertensive patient management (medicines and office visits), as in diagnosis equipment.