Pollen-induced allergic asthma and rhinoconjunctivitis: differences in outcome between seasonal and nonseasonal exposure to allergens under real-life conditions (The LANDSCAPE Study)

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Quality Standards for Allergen Immunotherapy Clinics in Spain: Consensus Document.

BACKGROUND AND OBJECTIVE: Allergen immunotherapy clinics (AITCs) in Spain differ widely in terms of structure, organization, resources, and portfolio of services. Therefore, it is essential to unify treatment criteria and define quality standards for the most complex AITCs. Objective: To establish a series of recommendations that make it possible to guarantee quality and safety in the administration of immunotherapy and define quality standards for the most complex AITCs. METHODS: This project began with an online survey of 65 allergy departments/units throughout Spain in 2013. Next, a 2-phase consensus process was carried out. In the first phase, 10 experts defined and agreed on the standards using the RAND/UCLA Appropriateness method; in the second, the agreements were validated by means of a 2-round Delphi consultation with 84 experts. RESULTS: Consensus was reached on minimum safety and quality criteria in the administration of allergen immunotherapy, and 2 levels of highly complex AITCs were defined: accredited AITCs and accredited AITCs with excellence. Consensus was also reached on quality standards and accreditation criteria for both levels. CONCLUSIONS: This project is pioneering in terms of its purpose (the definition of quality standards for AITCs) and of the use of structured participation techniques (combination of the RAND/UCLA and Delphi methods). It enabled the design of minimum standards for quality and safety in administering AIT, as well as quality criteria for accreditation of AITCs supported by a broad panel of experts from the Spanish Society of Allergology and Clinical Immunology.

Quality standards for allergen immunotherapy clinics in Spain: consensus document

BACKGROUND: Allergen immunotherapy clinics (AITCs) in Spain differ widely in terms of structure, organization, resources, and portfolio of services. Therefore, it is essential to unify treatment criteria and define quality standards for the most complex AITCs. OBJECTIVE: To establish a series of recommendations that make it possible to guarantee quality and safety in the administration of immunotherapy and define quality standards for the most complex AITCs. METHODS: This project began with an online survey of 65 allergy departments/units throughout Spain in 2013. Next, a 2-phase consensus process was carried out. In the first phase, 10 experts defined and agreed on the standards using the RAND/UCLA Appropriateness method; in the second, the agreements were validated by means of a 2-round Delphi consultation with 84 experts. RESULTS: Consensus was reached on minimum safety and quality criteria in the administration of allergen immunotherapy, and 2 levels of highly complex AITCs were defined: accredited AITCs and accredited AITCs with excellence. Consensus was also reached on quality standards and accreditation criteria for both levels. CONCLUSIONS: This project is pioneering in terms of its purpose (the definition of quality standards for AITCs) and of the use of structured participation techniques (combination of the RAND/UCLA and Delphi methods). It enabled the design of minimum standards for quality and safety in administering AIT, as well as quality criteria for accreditation of AITCs supported by a broad panel of experts from the Spanish Society of Allergology and Clinical Immunology

ANTECEDENTES: Las unidades de inmunoterapia (UIT) en España son muy diferentes en cuanto a estructura, organización, recursos y cartera de servicios. Por ello, resulta esencial homogeneizar criterios de actuación y definir estándares de calidad para las UIT de mayor complejidad. OBJETIVO: Establecer recomendaciones que permitan garantizar la calidad y seguridad en la administración de la inmunoterapia y definir estándares de calidad para las UIT de mayor complejidad. MÉTODOS: Proyecto iniciado (año 2013) con una encuesta on-line a 65 servicios o unidades de alergología de toda España. Posteriormente, se desarrolló un proceso de consenso en dos fases. En la primera, diez expertos definieron y consensuaron los estándares mediante el método RAND/UCLA; en la segunda, los acuerdos se validaron mediante una consulta Delphi a dos rondas con 84 expertos. RESULTADOS: Se consensuaron criterios mínimos de seguridad y calidad en la administración de inmunoterapia con alérgenos (ITA) y se definieron dos niveles de UIT de mayor complejidad: las UIT acreditadas (UITA) y las UIT acreditadas con excelencia (UITAE), consensuándose también los estándares de calidad y criterios de acreditación para ambos niveles. CONCLUSIONES: Proyecto pionero en su objetivo - definición de estándares de calidad de UIT- y en el empleo de técnicas de participación estructuradas -combinación de los métodos RAND/UCLA y Delphi-. El resultado es la definición de unos mínimos de calidad y seguridad para administrar ITA, y un conjunto de criterios de calidad para la acreditación de las UIT que cuenta con el respaldo de un amplio panel de expertos de la SEAIC

Consensus document on the diagnosis of severe uncontrolled asthma.

BACKGROUND: The concepts of asthma severity, control, and exacerbation are important in the evaluation of patients and their response to treatment. However, terminology is not standardized, and terms are often used interchangeably. Patients with uncontrolled severe asthma pose a major health care problem. Over the last decade, it has become increasingly clear that, in order to facilitate the development of novel targeted therapies, patients must be further characterized and classified. OBJECTIVE: To draft a consensus statement on the diagnosis, management, and treatment of severe uncontrolled asthma. The statement is meant to serve as a guideline for health professionals and clinical researchers. METHODS: The consensus was led by the Severe Asthma Working Group of the Spanish Society of Allergology and Clinical ImmunologyAsthma Committee. A review was conducted of the best available scientific evidence (until December 2011) on severe asthma in adults and children. RESULTS: Definitions for severe asthma, level of control, and exacerbation are developed. Different phenotypes and endophenotypes of severe uncontrolled asthma and new specific therapeutic interventions are presented. A systematic algorithm for the evaluation of patients presenting with severe persistent asthma symptoms is proposed. CONCLUSIONS: A consensus statement on the diagnosis, management, and treatment of severe uncontrolled asthma is presented.

Epileptic consciousness: concept and meaning of aura.

This research is based on previous publications that have analyzed certain neuropsychological phenomena that always have the same characteristic clinical features: a vivid experience of sudden onset and automatic development, accompanied by an intense sensation of strangeness. When these automatisms are accompanied by only mental symptoms, the designation paroxysmal psychic automatisms (PPAs) is proposed, and they should be interpreted as partial seizures (PSs) with a psychic content whenever they clearly exhibit the four features of suddenness, passivity, intensity, and strangeness. This interpretation is based on the existence of a wealth of scientific literature indicating an overlap between PPAs and PSs; moreover, bibliographic reviews indicate that the clinical signs just defined as characterizing PPAs are precisely those defining the epileptic consciousness.

Metástasis clavicular por carcinoma ex-adenoma pleomorfo de glándula submaxilar / Clavicle metastases of carcinoma expleomorphic adenoma of the submaxillary gland

El Carcinoma ex-adenoma pleomorfo (CEAP) es una neoplasia de glándula salival infrecuente que junto al Tumor Mixto Maligno Verdadero o Carcinosarcoma y al Tumor Mixto Metastatizante, constituyen el grupo de los "Tumores Mixtos Malignos" (O.M.S 1991). Dicho término puede llevar a confusión, ya que incluye tres entidades clínico - patológicas distintas . En una revisión de las 100 neoplasias salivales diagnosticadas en nuestro servicio en los últimos ocho años, hemos encontrado cuatro casos de CEAP. Tres se localizaron en glándula parótida y uno en glándula submaxilar. Este último metastatizó en región clavicular homolateral. Dos de los casos correspondieron a carcinomas mucoepidermoides, uno a carcinoma mioepitelial y el restante a un carcinoma polimorfo de bajo grado (carcinoma de los conductos terminales). El CEAP representa la transformación maligna del componente epitelial de un adenoma pleomorfo preexistente. El riesgo de transformación maligna de un adenoma pleomorfo es directamente proporcional a su tiempo de evolución en ausencia de tratamiento. El CEAP puede dar metástasis en los ganglios linfáticos regionales, pulmón, órganos abdominales, cerebro y huesos, siendo estas últimas más frecuentes a nivel de la columna vertebral. Presentamos por su excepcionalidad, el caso de un CEAP en un varón de 78 años de edad, que afectó a la glándula submaxilar, y que cursó con una metástasis ósea clavicular homolateral. Asimismo, se realiza una revisión de la literatura (AU)

Politraumatizado grave. / Critical polytraumatized

Se indican las caracteristicas que definen al politraumatizado critico, haciendo hincapie en que su estudio y tratamiento debe realizarse en equipo. Se hace un analisis de los niveles de agresion y de las respuestas funcionales consecutivas. Se describe a fisiopatologia de las principales repercusiones sistemicas, en especial la respuesta hemodinamica hormonal, enzimatica y metabolica, asi como las alteraciones en la coagulacion y su relacion con la microtrombosis. Se mencionan los principales organos de choque: pulmon, cerebro, rinon, tubo digestivo e higado, recalcando que el politraumatizado critico es el de estudio, evaluacion, tratamiento y evolucion mas dificiles y complicados. La captacion de las alteraciones criticas y su manejo inmediato debe seguir un orden prioritario, recalcando que lo primero un orden prioritario, reclamando que lo primero es conservar la vida y secundariamente, el organo, miembro, funcion y estetica