Opiniones y experiencias de profesionales sanitarios en el manejo nutricional del paciente oncológico: estudio ONA / Opinions and experiences of healthcare professionals in the nutritional management of oncology patients: the ONA study

Objetivos: un abordaje inadecuado de la desnutrición en el paciente con cáncer puede conducir a un empeoramiento de su calidad de vida y una respuesta deficiente al tratamiento. El estudio ONA (Oncología, Nutrición y Adherencia) tiene como objetivo describir el manejo nutricional del paciente con cáncer en la práctica clínica, así como las opiniones de los profesionales sanitarios involucrados en el mismo. Métodos: estudio observacional, descriptivo y transversal dirigido a profesionales sanitarios españoles. El cuestionario online fue diseñado a partir de una revisión bibliográfica, un grupo focal de pacientes (n = 6) y un comité científico multidisciplinar (n = 5), y distribuido por las sociedades científicas que avalan el estudio. Resultados: de los 461 profesionales sanitarios participantes, el 95,0 % consideraron fundamental la figura del profesional sanitario con formación específica en nutrición, pero el 22,8 % no tenían acceso a ella y solo el 49,0 % habían recibido formación. El 58,4 % afirmaron realizar el cribado nutricional o derivar al paciente para este fin. El 86,6 % de los participantes indicaron que se informa al paciente sobre aspectos nutricionales y consideraron que este estaba moderadamente satisfecho con la información recibida. En caso de detectarse desnutrición o riesgo de desnutrición, los profesionales afirmaron realizar una evaluación nutricional completa (73,1 %) y, de necesitarse soporte nutricional, este se prescribiría/recomendaría (87,4 %), evaluándose la adherencia al mismo (86,8 %). Conclusiones: a pesar de que la desnutrición es un problema común en el paciente con cáncer, casi la mitad de los profesionales no realizan un cribado nutricional. Además, el proceso de información y evaluación de la adherencia nutricional es subóptimo (AU)

Objectives: an inadequate approach to prevent malnutrition in cancer patients may worsen their quality of life and reduce their response to treatment. This study aims to describe the nutritional management of cancer patients in clinical practice, as well as the opinions of the healthcare professionals (HCPs) involved. Methods: this was an observational, descriptive, cross-sectional study addressed to HCPs in the Spanish healthcare setting. The online questionnaire was designed based on a literature review, one focus group of patients (n = 6), and the experience of the multidisciplinary scientific committee (n = 5), and was distributed by the scientific societies endorsing the study. Results: a total of 461 HCPs answered the survey. Most of them considered that a nutrition expert (95.0 %) is essential for the nutritional management of patients. However, 22.8 % of HCPs did not have access to this expert, and only 49.0 % had received training. Nutritional screening or patient referral for screening was performed by 58.4 % of HCPs. Of the total of HCPs, 86.6 % stated that nutritional information is provided to patients and considered them moderately satisfied with the information received. In malnourished patients or in those at risk of malnutrition, a complete nutritional assessment was performed by HCPs (73.1 %). Most HCPs (87.4 %) reported prescribing or recommending nutritional support if needed, and assessing adherence (86.8 %). Conclusions: despite malnutrition being a common problem in cancer patients, almost half of professionals do not perform any nutritional screening. In addition, patient information and assessment of nutritional adherence appear to be suboptimal (AU)

Evaluation of the eazyplex MRSA assay for the rapid detection of Staphylococcus aureus in pleural and synovial fluid.

OBJECTIVE: Loop-mediated isothermal amplification (LAMP) is a simple and sensitive technique for rapid microbiological diagnosis. The aim of this study was to evaluate the analytical and diagnostic performance of the LAMP eazyplex MRSA test for the direct detection and differentiation of methicillin-susceptible (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) in synovial/pleural fluid. METHODS: Analytical validation included the determination of the limit of detection (LoD) and analytical specificity of the eazyplex MRSA test. A diagnostic evaluation of the eazyplex test against bacterial culture was performed on routine pleural/synovial samples collected prospectively from patients aged less than 18 years with complicated pneumonia with empyema or arthritis admitted to the Children's Hospital Sant Joan de Déu in Barcelona, Spain, between April 2015 and May 2016. RESULTS: The new system appropriately detected a quality control panel of clinical samples with DNA of MSSA, MRSA, and other pathogens. The LoD was established at 6.4×103 CFU/ml for S. aureus and 1.0×104 CFU/ml for MRSA. Diagnostic validation of the eazyplex MRSA assay was performed on 51 prospective clinical invasive samples, resulting in sensitivity and specificity values of 83.3% and 97.8%, respectively, for S. aureus detection. The mean turnaround time was 70min. CONCLUSIONS: The eazyplex MRSA assay was found to be a useful test for the rapid detection of S. aureus in invasive samples such as pleural/synovial fluid.

Heterophoria and fixation disparity: a review.

Heterophoria does not provide a reliable clue for ordering prisms in an asthenopic patient. The same reservation applies to associated phoria, as determined by prism correction of fixation disparity. Subjective tests for fixation disparity, even those with a fusionable fixation target, do not correctly indicate the vergence position of the eyes under natural viewing conditions. Attempts to measure fixation disparity on the basis of stereo disparity, using the "Measuring and Correction Methods of H.-J. Haase", have failed.

[Can fixation disparity be detected reliably by measurement and correctional techniques according H.J. Haase (MKH)?]. / Ist die Feststellung einer Fixationsdisparation mit der Mess- und Korrektionsmethodik nach H.-J. Haase (MKH) verlässlich?

BACKGROUND: The theory of the "Measuring and Correction Methods of H.-J. Haase" (MCH) states that a small misalignment of one eye, called fixation disparity, indicates a difficulty in overcoming a "vergence position of rest" that is different from ortho position. This difficulty, so the theory, can cause asthenopic complaints, such as headaches, and these complaints can be relieved by prisms. The theory further claims that fixation disparity can be ascertained by a series of tests which depend on the subject's perception. The tests most decisive for the diagnosis of a so-called fixation disparity type 2 consist of stereo displays. The magnitude of the prism that allows the subject to see the test configurations in symmetry is thought to be the one that corrects the "vergence position of rest". METHODS: Nine subjects with healthy eyes in whom a "fixation disparity type 2" had been diagnosed were selected for the study. Misalignment of the eyes was determined according to the principle of the unilateral cover test. Targets identical for both eyes were presented on the screen of the Polatest E. Then, the target was deleted for one eye and the ensuing position change of the other eye was measured, using the search coil technique. This test was performed both with and without the MCH prism. RESULTS: In all 9 subjects the misalignment was less than 10 minutes of arc, i.e. in the range of normal fixation instability. Averaging across the 9 subjects, the deviation of the eye (misaligned according to MCH) was 0.79 +/- 3.45 minutes of arc in the direction opposed to that predicted by the MCH, a value not significantly different from zero. The MCH prism elicited a fusional vergence movement the magnitude of which corresponded to the magnitude of the MCH prism. CONCLUSION: Ascertaining fixation disparity with the MCH is unreliable. Accordingly, it appears dubious to correct a "vergence position of rest" on the basis of the MCH.

Primary repair of the cholecyst-enteric fistula in gallstone ileus.

Gallstone ileus is a rare cause of mechanical bowel obstruction. The attendant lack of awareness by the clinician will not only result in the diagnosis being made intraoperatively but will also affect the adequacy of the preoperative preparation of these ill patients. These patients are often elderly, septic and have significant concomitant medical illnesses. Recently two patients with gallstones ileus were managed with enterolithotomy and primary repair of the cholecyst-duodenal fistula at the University Hospital of the West Indies, Jamaica. Their clinical presentations and progress are described along with a review of the classical clinical course, radiological features, and operative choices available.

Biliary surgery in patients with sickle-cell anaemia.

The results of biliary surgery are reported in 12 consecutive patients with homozygous sickle-cell (SS) disease treated over a two-year period at the University Hospital of the West Indies, Kingston, Jamaica. Recommendations for the surgical management of these patients are outlined.