ABSTRACT
We report on trends in anaphylaxis admissions in the Spanish hospital system during the period 1998-2011. Data on admissions for anaphylaxis were obtained from the Spanish Information System for Hospital Data for the period 1998-2011. Patients were selected using the codes for anaphylaxis in the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Poisson regression models were used to estimate incidence rate ratios. We recorded a 1.89-fold increase in admissions for anaphylaxis in Spanish hospitals during the study period, particularly in patients aged 0-14 years (1.65- to 3.22-fold until 2009 and 4.09- to 12.59-fold until 2011) and in food anaphylaxis in all age groups (2.78-fold until 2009 and 8.74-fold until 2011). The incidence of anaphylaxis is perceived as having increased in recent years, especially anaphylaxis caused by food and anaphylaxis affecting the pediatric population.
Subject(s)
Anaphylaxis/epidemiology , Hospitalization , Adult , Aged , Anaphylaxis/etiology , Anaphylaxis/history , Female , History, 20th Century , History, 21st Century , Humans , Incidence , Male , Middle Aged , Population Surveillance , Spain/epidemiologyABSTRACT
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)
Subject(s)
Humans , Female , Adult , Middle Aged , Anesthesia, Local , Pain Management/methods , Pain Management , Breast Neoplasms/diagnosis , Breast Neoplasms/rehabilitation , Botulinum Antitoxin/therapeutic use , Mastectomy/rehabilitation , Mastectomy , Breast Implants/trends , Breast Implants , Anesthesia, Local/trends , Anesthesia, Local/methods , Prostheses and Implants , Quality of Life , Pain/etiology , Carcinoma/rehabilitation , Carcinoma/surgeryABSTRACT
La elaboración de protocolos y la medida de su cumplimiento mejoran la calidad asistencial. Actividades promovidas por los sistemas de vigilancia de infección nosocomial se deben potenciar y someter a evaluación por afectar al cuidado del paciente, a su calidad de vida y resultados clínicos. La ducha y los enjuagues con clorhexidina forman parte del protocolo de preparación prequirúrgica del paciente y son recomendados en las guías por disminuir la infección de herida quirúrgica y neumonía posquirúrgica. Hemos llevado a cabo un estudio descriptivo transversal de evaluación de la adecuación a estos aspectos del protocolo de preparación requirúrgica en pacientes operados de prótesis de cadera. Se ha encontrado un grado de cumplimiento global del 59%; 88,5% para la ducha con jabón de clorhexidina al menos 24 horas antes de la cirugía y 63% para el colutorio con antiséptico. Estos resultados muestran una necesidad de mejora con medidas correctoras como pueden ser la entrega de normas por escrito y una mayor implicación tanto por parte del personal como del paciente (AU)
Protocols production and the measurement of their compliance are useful to improve health assistance quality. Surveillance infection at hospital is a process to evaluate because it affects to patient care, life quality and clinical results. Shower and rinsing with clorhexidine are part of pre-surgical patient preparation and they are recommended in the guides because they reduce surgical wound infection and post-surgical pneumonia. This study evaluates the compliance and appropriatness of several activities in pre-surgical preparation (shower and oropharyngeal wash with clorhexidine). Transverse study of adaptation to some activities of a protocol of pre-surgical patient preparation in hip replacement. Average comparation is carried out with t student and percentage of protocol adaptation. Global compliance grade was 59%, of which 88,5% was for the shower with clorhexidine with at least 24 hours before surgery and 63% was regarding mouthwash. The use of protocols must be bound to systematic evaluation of its compliance (AU)
