Early identification of local infections in central venous catheters for hemodialysis: A systematic review.

BACKGROUND: The use of central venous catheters (CVC) is associated with higher morbidity and mortality, related to infectious complications, contributing to poorer clinical outcomes and increased healthcare costs. According to the literature, the incidence of local infections related to CVC for hemodialysis is highly variable. This variability is related to differences in definitions of catheter-related infections. OBJECTIVE: To identify signs and symptoms for determining local infections (exit site and tunnel tract infections) used in the literature in tunnelled and nontunnelled CVC for hemodialysis. DESIGN: Systematic review METHODS: Structured electronic searches were conducted in five electronic databases, from 1 January 2000-31 August 2022, using key words and specific vocabulary, as well as manual searches in several journals. Additionally, vascular access clinical guidelines and infection control clinical guidelines were reviewed. RESULTS: After validity analysis, we selected 40 studies and seven clinical guidelines. The definitions of exit site infection and tunnel infection used in the different studies were heterogeneous. Among the studies, seven (17,5 %) used the definitions of exit site and tunnel infection based on a clinical practice guideline. Three of the studies (7.5 %) used the Twardowski scale definition of exit site infection or a modification. The remaining 30 studies (75 %) used different combinations of signs and symptoms. CONCLUSIONS: Definitions of local CVC infections are highly heterogeneous in the revised literature. It is necessary to establish a consensus regarding the definitions of hemodialysis CVC exit site and tunnel infections. REGISTRATION: PROSPERO (CRD42022351097).

Formación en una estrategia multimodal sobre el cuidado de los catéteres venosos periféricos: impacto en la preservación del árbol vascular de pacientes de una unidad de nefrología / Training in a multimodal strategy on the care of peripheral venous catheters: impact on the preservation of the patient's vascular tree in a nephrology unit

Introducción: Un desarrollo adecuado de las fístulas arteriovenosas está relacionado con el estado del árbol vascular y el uso previo de dispositivos de acceso venoso periférico (CVP). Objetivo: Evaluar el impacto de la formación en una estrategia multimodal para reducir las complicaciones relacionadas con el CVP en una unidad de hospitalización de nefrología. Material y Método: Estudio cuasi-experimental pre-post intervención, en pacientes portadores de CVP en una unidad de hospitalización de nefrología. La intervención consistió en la formación en una estrategia multimodal para el manejo de CVP basada en 5 medidas basadas en evidencia. Para determinar el impacto se analizaron los registros electrónicos de los CVP insertados en los 3 meses previos a la actividad formativa (PRE) vs 3 meses posteriores (POST). Se realizó un análisis descriptivo e inferencial de las variables a estudio. Resultados: CVP estudiados: PRE n=96, POST n=120. Número medio de CVP/paciente: PRE 2,07 vs POST 1,75 (p=0,02). Calibre: PRE 18G 1%, 20G 18%, 22G 80%, 24G 1%; POST 20G 20%, 22G 80% (p=NS). Duración media: PRE 192h, <7 días 26% vs POST 171h, <7 días 30% (p=NS). Causas de retirada: Alta / no precisa PRE 41% vs POST 38% (p=NS), Flebitis PRE 27% vs POST 13% (p=NS). Conclusiones: la formación en una estrategia multimodal ha conseguido reducir: número de CVP por paciente, número de flebitis, uso de CVP de mayor calibre y tiempo que permanecen insertados. Una estrategia multimodal sobre el manejo de los CVP puede ayudar a preservar el árbol vascular en pacientes nefrológicos

Introduction: An adequate development of arteriovenous fistulas is related to the state of the vasculature and the previous use of peripheral venous catheter (PVC). Objective: To evaluate the impact of training in a multimodal strategy to reduce complications related to PVC in a nephrology hospitalization unit. Material and Method: Quasi-experimental pre-post intervention study in patients with PVC in a nephrology hospitalization unit. The intervention was training in a multimodal strategy for PVC management based on 5 evidence-based measures. To determine the impact, the electronic medical records of the PVCs inserted in the 3 months prior to the training activity (PRE) versus 3 months later (POST) were analyzed. A descriptive and inferential analysis of the variables to be studied was performed. Results: PVC studied: PRE n=96, POST n=120. Average number of PVC/patient: PRE 2.07 vs. POST 1.75 (p=0.02). Caliber: PRE 18G 1%, 20G 18%, 22G 80%, 24G 1%; POST 20G 20%, 22G 80% (p=NS). Average duration: PRE 192h, <7 days 26% vs POST 171h, <7 days 30% (p = NS). Withdrawal causes: High/not accurate PRE 41% vs POST 38% (p=NS), Phlebitis PRE 27% vs POST 13% (p=NS). Conclusions: Training in a multimodal strategy has managed to reduce: number of PVC per patient, number of phlebitis, use of PVC of greater caliber and time that remain inserted. A multimodal strategy on the PVCs management can help preserve the vascular tree in nephrological patients

Lesión cribiforme en la cara de un varón de 44 años de edad.

El acantoma de la vaina pilosa es un tumor benignode piel muy poco frecuente. Suele presentarse comouna pápula asintomática, con un orificio central y lalocalización más frecuente es la cara. Presentamos unnuevo caso de acantoma de vaina pilosa, apoartandoimagen dermatoscópica del tumor.

The management of lactose intolerance among primary care physicians and its correlation with management by gastroenterologists: the SEPD-SEMG national survey.

INTRODUCTION AND AIMS: The understanding of lactose intolerance (LI) is limited in some professional settings. Sociedad Española de Patología Digestiva (SEPD) and Sociedad Española de Medicina General (SEMG) have developed a survey in order to: a) Analyze primary care physicians (PCPs) knowledge and clinical management; and b) to compare results with those of a previous survey of Spanish gastroenterologists (GEs). MATERIAL AND METHODS: An online questionnaire was sent to SEMG members with 27 items on various issues: Demographics, occupational characteristics, outlook on LI, diagnostic tests, treatment, and follow-up. Results were compared to those from a survey of GEs. RESULTS: A total of 456 PCPs responded, versus 477 GEs. PCPs had an older mean age and longer professional experience. Level of understanding of LI was similar, albeit a higher proportion of PCPs lacked epidemiological awareness (p < 0.01). GEs tended to consider LI a "minor" condition (71.3 vs. 40.1%; p > 0.001), and LI symptoms as overlapping those of irritable bowel syndrome (93.5 vs. 88.2%; p = 0.005), although symptoms perceived as suspicious of LI were similar in both groups. Dietary recommendations were recognized as the primary therapeutic approach. CONCLUSION: This study reveals the outlook of PCPs on LI, and allows comparison with that of GEs, as a basis for the development of strategies aimed at improving LI understanding, approach and management in our setting.

Manejo de la intolerancia a la lactosa entre los médicos de atención primaria y su correlación con la de los especialistas en digestivo: encuesta nacional SEPD-SEMG / The management of lactose intolerance among primary care physicians and its correlation with management by gastroenterologists: The SEPD-SEMG national survey

INTRODUCCIÓN Y OBJETIVOS: el conocimiento sobre la intolerancia a la lactosa (IL) es limitado en algunos ámbitos profesionales. La Sociedad Española de Patología Digestiva (SEPD) y la Sociedad Española de Medicina General (SEMG) han elaborado una encuesta con los objetivos de: a) analizar el nivel de conocimiento y de manejo clínico de los médicos de atención primaria (MAP); y b) comparar sus resultados con los de la encuesta ya realizada entre los gastroenterólogos españoles (GE). MATERIAL Y MÉTODOS: se envió un cuestionario online a los socios de la SEMG, con 27 preguntas sobre distintas cuestiones: demografía y características laborales, actitud frente a la IL, métodos de diagnóstico, tratamiento y seguimiento. Los resultados fueron comparados con los de la encuesta a GE. RESULTADOS: se recopilaron 456 respuestas de MAP, que se compararon con las proporcionadas por 477 GE. Los MAP presentaron una edad media y experiencia profesional mayor. El nivel de conocimiento sobre IL fue parecido, si bien una mayor proporción de MAP desconocía la epidemiología del problema (p < 0,01). Los GE tendieron a considerar a la IL una patología "menor" (71,3 vs. 40,1%; p > 0,001), y a sus síntomas superponibles a los del síndrome del intestino irritable (93,5 vs. 88,2%; p = 0,005), si bien los síntomas reconocidos como sospechosos de IL fueron similares entre ambos grupos. Las recomendaciones dietéticas fueron reconocidas como la principal medida terapéutica. CONCLUSIÓN: este estudio permite conocer la actuación de los MAP ante la IL y compararla con la de los GE, como base para el desarrollo estrategias para mejorar el conocimiento, actitud y tratamiento de la IL en nuestro medio

INTRODUCTION AND AIMS:The understanding of lactose intolerance (LI) is limited in some professional settings. Sociedad Española de Patología Digestiva (SEPD) and Sociedad Española de Medicina General (SEMG) have developed a survey in order to: a) Analyze primary care physicians (PCPs) knowledge and clinical management; and b) to compare results with those of a previous survey of Spanish gastroenterologists (GEs). MATERIAL AND METHODS: An online questionnaire was sent to SEMG members with 27 items on various issues: Demographics, occupational characteristics, outlook on LI, diagnostic tests, treatment, and follow-up. Results were compared to those from a survey of GEs. RESULTS: A total of 456 PCPs responded, versus 477 GEs. PCPs had an older mean age and longer professional experience. Level of understanding of LI was similar, albeit a higher proportion of PCPs lacked epidemiological awareness (p < 0.01). GEs tended to consider LI a "minor" condition (71.3 vs. 40.1%; p > 0.001), and LI symptoms as overlapping those of irritable bowel syndrome (93.5 vs. 88.2%; p = 0.005), although symptoms perceived as suspicious of LI were similar in both groups. Dietary recommendations were recognized as the primary therapeutic approach. CONCLUSION: This study reveals the outlook of PCPs on LI, and allows comparison with that of GEs, as a basis for the development of strategies aimed at improving LI understanding, approach and management in our setting