Use of cannabinoids for acute postoperative pain.

Doubts about the efficacy of medicinal cannabis in the treatment of acute postoperative pain are well justified, at least in light of the information gathered from Google Scholar, Clinical Trials, PubMed, and Cochrane databases.The conflation of cannabis and cannabinoids engenders not only normative but also medical implications. Despite cannabinoids having evinced their efficacy in the treatment of various pathologies, they have yet to demonstrate such in the context of acute postoperative pain. The burgeoning corpus of research on this subject does instill a modicum of hope in this regard; nevertheless, the manifold methodological approaches employed obfuscate the prospect of reaching unequivocal conclusions.Given the current status of this matter, this article abstains from making a definitive pronouncement either in favor of or against the role of pharmaceuticals incorporating cannabinoid compounds in the management of acute postoperative pain.

Papel de N-acetilcisteína (NAC) en pacientes con tabaquismo / Role of N-acetylcysteine (NAC) in patients with smoking

Antecedentes y objetivo. El tabaquismo es el principal factor de riesgo de la enfermedad pulmonar obstructiva crónica (EPOC). N-acetilcisteína (NAC) es un agente mucolítico con propiedades antioxidantes y antiinflamatorias que ha demostrado ser eficaz en la reducción de la tasa de exacerbaciones y mejoría clínica de los pacientes con EPOC. El objetivo del trabajo es conocer la opinión de terapeutas expertos acerca del perfil o perfiles de los pacientes fumadores que pueden ser candidatos al uso de NAC. Métodos. Se efectuó una encuesta distribuida a las unidades de tabaquismo de España y una Reunión de Expertos en tabaquismo y EPOC, en la que los Expertos pudieron debatir abiertamente los tópicos seleccionados. Resultados. Los expertos reconocieron el papel del tabaquismo en la generación de estrés oxidativo y concordaron en emplear la terapia mucolítica/antioxidante para fumadores o exfumadores con síntomas respiratorios. Se debatió la necesidad de ampliar las indicaciones de esta terapia a otros perfiles de pacientes. Se señaló también el potencial efecto preventivo de la NAC sobre el daño pulmonar por su acción antioxidante, aunque se necesitaría más evidencia en este ámbito específico del tabaquismo. Se puso énfasis en diferenciar la dosis de NAC como mucolítico (600 mg/día)o antioxidante (1.200 mg/día). Conclusiones. Los expertos valoraron a NAC como un fármaco bien tolerado, de sencillo uso, con un conocido buen perfil de seguridad y un gran potencial para lograr los objetivos terapéuticos por su alta capacidad antioxidante. (AU)

Background and objective. The smoking habit is the main risk factor for chronic obstructive pulmonary disease (COPD). N-Acetylcysteine (NAC) is a mucolytic agent with antioxidant and anti-inflammatory properties that has been demonstrated to be effective in the reduction of the rate of exacerbations and clinical improvement of patients with COPD. This study aims to know the opinion of the expert therapists on the profile(s) of the patients who smoke and who may be candidates for the use of NAC. Methods. A survey was performed, distributing it to the smoking units in Spain and to a Meeting of Experts on the smoking habit and COPD in which the Experts could openly debate on the selected topics. Results. The experts recognized the role of the smoking habit in the generation of oxidative stress and agreed to use the mucolytic/antioxidant treatment for smokers or ex-smokers with respiratory symptoms. The need to extend the indications of this therapy to other patient profiles was debated. The potential preventive effect of NAC on lung damage due to its antioxidant action was also pointed out, although more evidence in this special area of the smoking habit would be necessary. Emphasis was placed on differentiating the NAC dose as a mucolytic (600 mg/day) or as an antioxidant (1,200 mg/day). Conclusions. The experts evaluated NAC as a drug that is well-tolerated, easy-to-use, with a known good safety profile and having great potential to achieve the therapeutic objectives due to its high antioxidant capacity. (AU)

Protocolo asistencial clínico-psicológico para el tratamiento del tabaquismo con citisina / Clinical-psychological care protocol for the treatment of smoking with cytisine

Citisina es un tratamiento farmacológico del tabaquismo que ha sido introducido recientemente en nuestro país. Los estudios realizados con el mismo durante los últimos años muestran que es un tratamiento eficaz y seguro utilizado a dosis decrecientes durante un periodo de 25 días. Sus específicas características de dosis y tiempo de duración hacen recomendable que se diseñe un protocolo asistencial clínico-psicológico para ser desarrollado durante la utilización de citisina. Un grupo multidisciplinario de profesionales sanitarios expertos en tabaquismo han consensuado un protocolo que recomiendan para llevar a cabo en aquellos pacientes a los que se prescriba citisina como fármaco para dejar de fumar. (AU)

Cytisine is a smoking cessation medication that has appeared recently in Spain. It is effective and safe for helping smokers to quit using for 25 days. Its specific characteristicis in doses and duration recommends to desing a protocol clinical-psychological. A multidisciplinary group of health professionals experts on smoking cessation has designed a protocol to develop with patients who are receiving cytisineas medication for smoking cessation. (AU)

Resistance profiles and risk factors of resistant microorganisms in bacteraemia of abdominal origin. / Perfiles de resistencia y factores de riesgo de microorganismos resistentes en bacteriemia de origen abdominal.

OBJECTIVE: The presence of resistant microorganisms is a major cause of failure in initial empirical antimicrobial therapy. The objectives of this study are to determine the resistance profile of microorganisms that cause bacteraemia of abdominal origin and to identify whether the previous use of antibiotics and the place of acquisition of bacteraemia are risk factors associated with the presence of resistant organisms. MATERIAL AND METHODS: A clinical, observational, epidemiological, retrospective cohort study was conducted with all the adult patients admitted to a university hospital from 2011-2013. Antimicrobial resistance profiles were described and a 95% confidence interval chi-square test was used to determine whether the variables studied were risk factors in the isolation of resistant microorganisms. RESULTS: Of the 1245 patients with bacteraemia, 212 (17%) presented bacteraemia of abdominal origin. The resistance profile highlights the incidence of methicillin resistant Staphylococcus aureus (50%), coagulase-negative staphylococci resistant to linezolid (20.58%), enterococci resistant to vancomycin (3.12%), Escherichia coli resistant to third-generation cephalosporins (9.9%) and fluoroquinolones (35.64%), Klebsiella pneumoniae resistant to third-generation cephalosporins (8.33%), Pseudomonas aeruginosa resistant to fluoroquinolones and carbapenem (25% and 25% respectively) and Acinetobacter baumanii resistant to fluoroquinolones and carbapenem (100% and 100% respectively), Candida albicans resistant to fluconazole (11.11%), single Candida krusei isolate resistant to fluconazole and Candida parapsilosis resistant to echinocandins (12.5%). In our study, previous use of antibiotics had a statistically significant association with the isolation of resistant microorganisms (P=.013) but not the place of acquisition of bacteraemia (P=.239). CONCLUSION: Establishing the incidence of resistant organisms can improve empirical antimicrobial therapy in patients with bacteraemia of abdominal origin. Previous use of antibiotics was statistically significantly related to the isolation of resistant microorganisms.

Characteristics and associated factors in patient falls, and effectiveness of the lower height of beds for the prevention of bed falls in an acute geriatric hospital

Objetivos: Existen estudios sobre caídas de pacientes en instituciones de larga estancia pero hay muy pocos en centros de agudos. Objetivo: analizar las características y los factores asociados de las caídas, y la efectividad de la disminución de la altura de las camas para reducir la frecuencia y los daños por caídas en un Hospital de Agudos Geriátricos. Métodos: Estudio descriptivo y retrospectivo usando un sistema de notificación de incidentes obligatorio, el Global Trigger Tool del IHI, y las reclamaciones relacionadas a caídas de pacientes entre los años 2007 y 2011 en un hospital de agudos geriátricos de 200 camas. Resultados: La tasa de caídas fue de 5,4 por 1000 pacientes día (1,3% produjo fracturas), con 6 exitus (0.6%). Cerca de la mitad de las caídas ocurrieron en el turno de noche (42,4%) y fueron más frecuentes en las Unidades de agudos (42,9%). Un 7,5% de los pacientes tuvo una caída previa al ingreso. Se produjeron 3 (0,2%) reclamaciones patrimoniales atribuibles a posible negligencia clínica. Las caídas de cama con la bajada de altura se han reducido un 28,3%, siendo las caídas con da˜no 1,88 veces menos que las ocurridas sin la bajada de la altura (RR 0,53 CI 95% 0,83-0,34) (p = 0,006). Conclusiones: La prevención de caídas de pacientes es una tarea importante en las Unidades geriátricas con una potencial reducción de costes y daños, algunas medidas como la bajada de la altura de la cama mostraron una reducción significativa de las caídas (AU)

Objectives: Whereas several studies about patient falls have provided data for long-term healthcare institutions, less information is available for acute care centres. The objective was to analyze the characteristics of the patient falls and associated factors, and the effectiveness of the lower beds’ height to reduce the frequency and the harms of the patient falls in an acute geriatric hospital. Methods: A descriptive and retrospective study using a mandatory safety incident report, the IHI Global Trigger Tool, and the claims related to patient falls between 2007 and 2011 in a 200-bed university-associated geriatric hospital. Results: The falls rate was 5.4 falls per 1000 patient days (1.3% of falls led to fractures) and there was exitus in 6 patients (0.6%). Nearly half of the falls ocurred during the night shift (42.4%). By wards, falls were more frequent in acute geriatric wards (42.9%). A 7.5% of patients had a fall before admission. 3 (0.2%) claims due to possible clinical negligence were found. A reduction (28.3%) of bed falls with the lower height of the bed and a 1.88 times less falls with harm (RR 0.53; CI 95% 0.83-0.34) (p = 0.006) was observed. Conclusion: The prevention of patient falls is an important task in geriatric units with a potential reduction of harms and costs, some measures such as the lower height of the bed showed a significant reduction of the falls (AU)

Characteristics and associated factors in patient falls, and effectiveness of the lower height of beds for the prevention of bed falls in an acute geriatric hospital.

OBJECTIVES: Whereas several studies about patient falls have provided data for long-term healthcare institutions, less information is available for acute care centres. The objective was to analyze the characteristics of the patient falls and associated factors, and the effectiveness of the lower beds' height to reduce the frequency and the harms of the patient falls in an acute geriatric hospital. METHODS: A descriptive and retrospective study using a mandatory safety incident report, the IHI Global Trigger Tool, and the claims related to patient falls between 2007 and 2011 in a 200-bed university-associated geriatric hospital. RESULTS: The falls rate was 5.4 falls per 1000 patient days (1.3% of falls led to fractures) and there was exitus in 6 patients (0.6%). Nearly half of the falls ocurred during the night shift (42.4%). By wards, falls were more frequent in acute geriatric wards (42.9%). A 7.5% of patients had a fall before admission. 3 (0.2%) claims due to possible clinical negligence were found. A reduction (28.3%) of bed falls with the lower height of the bed and a 1.88 times less falls with harm (RR 0.53; CI 95% 0.83-0.34) (p=0.006) was observed. CONCLUSION: The prevention of patient falls is an important task in geriatric units with a potential reduction of harms and costs, some measures such as the lower height of the bed showed a significant reduction of the falls.

Recomendaciones para la vacunación neumocócica en fumadores / Recommendations for pneumococcal vaccination in smokers

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[New options in the treatment of painful shoulder syndrome]. / Nuevas alternativas en el tratamiento del síndrome de hombro doloroso.

Shoulder pain is a common complaint in clinical practice in Primary Care and affects 20% of the general population. The usual form of treatment is based on NSAIDs, rest, rehabilitation and, as an alternative, a local injection into the joint. There are also radiofrequency techniques on the suprascapular nerve in the cases of refractory pain to these therapies. Radiofrequency can be used in two ways: Conventional Radiofrequency, using high temperatures to the target tissue with the aim of producing a thermal neurolysis and Pulsed Radiofrequency where the temperatures are lower and produces a temporary non-destructive blockage; the latter being the most common technique in the management of shoulder pain. Although the analgesic mechanism of action of Radiofrequency is unknown, recent studies have shown that it is safe, effective and Lasting. Radiofrequency of the suprascapular nerve is a valid, effective and with few complications in the treatment of shoulder pain refractory to other therapies.

Neumonía adquirida en la comunidad y bacteriemia por Alcaligenes xylososidans / Community-acquired pneumonia and bacteriemia due to Alcaligenes xylososidans

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Empowerment profesional en la atención primaria médica española / Professional empowerment in spanish medical primary care

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[Health care expenditure in Spain compared with developed Europe, 1985-2001. The Spanish primary health care, the European Cinderella]. / El gasto sanitario en España en comparación con el de la Europa desarrollada, 1985-2001. La atención primaria española, Cenicienta europea.

OBJECTIVE: To describe the evolution of the funds distribution in our health care system since the start of the primary care reform to 2001, in comparison with the European countries members of the Organisation for Economic Co-operation and Development (OECD). DESIGN: A longitudinal descriptive and retrospective study. PARTICIPANTS: European countries members of the OECD. SETTING: Countries members of the OECD. METHODS: The data come from the OECD database Health Data 2003. The data refer to period 1985-2001, and to a group of variables of health care expenditure by sectors and of income (Gross Domestic Product [GDP] per capita). We compare Spanish data series with those of the group of 22 European members countries of the OECD. RESULTS: Europe increased public expenditure on out-patient care both as a percentage of public health care expenditure and as a percentage of GDP. Spain reduced public expenditure on out-patient care in both senses. Spanish public expenditure on in-patient care reduced a great part of its difference with Europe so that since 1995 it is found, as a percentage of GDP, in the European average and, as per capita, it is according with the Spanish income. In contrast, public expenditure on out-patient care as a percentage of GDP in Spain is very much lower than the European average and, as per capita, is very much lower than the Spanish income. The Spanish private expenditure on out-patient is found among the highest in Europe and, compared with Europe, exceeds very much Spanish income, in contrast with his homonymous public. The Spanish private expenditure on in-patient care is found among the lowest in Europe and, compared with Europe, is very much lower than Spanish income level. CONCLUSIONS: With respect to public resources assigned, the reform of primary care in Spain has not been useful to approach Spanish primary health care level to Europe, in contrast with the Spanish hospital level. The difference between Spain and Europe in public expenditure on out-patient care as a percentage of GDP is, even, bigger than the one there was when the reform of Spanish primary care started.

Carrera profesional, motivación y compromiso con la organización

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Fracturas osteoporóticas en un paciente varón joven hemocromatósico / Osteoporotic fractures in a male young patient with hemochromatosis

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