Definición de indicadores para una atención centrada en el paciente diabético tipo II. Estudio de consenso.

OBJECTIVE: Define a minimum set of indicators for person-focused-care applying for type 2 diabetes mellitus (DM2), as a complementary metric to current clinical-healthcare indicators. METHODS: Qualitative consensus-building study (involving professionals and patients) structured in three stages: Metaplan to capture information, Delphi to agree on criteria and indicators, and consensus conference to ensure feasibility and relevance of the proposal. RESULTS: Consensus was reached on a total of nine indicators upon: shared decision-making, self-care, adherence, renal function screening, activities of daily living, individualized therapeutic plan, vascular risk assessment, working life and human treatment. These indicators were grouped into three dimensions: the person with oneself, the person with one's family, and the person with the health system. CONCLUSIONS: These indicators make it possible to establish alternative metrics to determine the degree of progress in a person-centered attention in case of DM2.

Efficacy of an information system addressed to nursing staff for diminishing contaminated blood cultures: a blind clinical trial.

OBJECTIVE: Evaluate the efficacy of an information system addressed to nursing staff to lower the blood culture contamination rate. METHODS: A blind clinical trial was conducted at Internal Medicine and Emergency Departments during 2011. After following a reeducation program in BC extraction, participants were randomly selected in a 1:1 ratio. Every participant of the experimental group was informed of each worker's individual performance; whereas the control group was only informed of the global results. RESULTS: A total of 977 blood extractions were performed in 12 months. Blood culture contamination rate was 7.5%. This rate was higher in the Emergency Department than in Internal Medicine (10% vs. 3.8%; p=0.001). Factors associated with the higher risk of contamination were, in the univariate analysis, the extraction through a recently implanted blood route and the time of professional experience, while those associated with a lower risk were the extraction in Internal Medicine and through a butterfly needle. On multivariate analysis, extraction through a recently placed access was an independent risk factor for an increased contamination rate (OR 2.29; 95%CI 1.18-4.44, p=0.014), while individual information about the blood culture results (OR 0.11; 95%CI 0.023-0.57; p=0.008), and more than 9 years of professional experience were asso-ciated with fewer contaminations (OR 0.30; 95%CI 0.12-0.77; p=0.012). In the intervention group the contamination rate diminished by a 26 %. CONCLUSIONS: Drawing blood cultures through a recently taken peripheral venous access increased their risk of contamination. The intervention informing the nurse staff of the contamination rate is effective to decrease it.

Healthcare accreditation as trigger of organisational change: The view of professionals.

BACKGROUND: Healthcare accreditation seeks to promote the organisational change in healthcare organisations from an approach that values the level of progress achieved through a validated reference framework. The aim of this paper is to analyse the role played by accreditation through the experience perceived by health professionals during the process of self-assessment and external evaluation, taking into account three dimensions of analysis: focus on the patient, internal organisation and leadership, and impact on the clinical aspects of healthcare. MATERIAL AND METHODS: Design: Semi-structured interviews with key informants from clinical management units (CMU) within the Andalusian Health System (Spain). PARTICIPANTS: The key informants in each CMU were the clinical leader, the head of nursing and two health professionals (doctors and nurses). A qualitative research protocol was employed to conduct the semi-structured interviews (n=52 interviews) with physicians and nurses, in order to analyse their experience with the accreditation process. RESULTS: The analysis identified four main outcomes related to the accreditation process perceived by professionals: (1) A benchmarking conceptualisation of the process; (2) Improvements in patient-centred care, quality of clinical records, and organisational culture of the units; (3) Improvement of patient safety culture; (4) As negative outcomes, a slight perception of bureaucratisation and standardisation of the clinical practice. CONCLUSIONS: The described initiative of accreditation process in Andalusia (Spain) is widely perceived as positive by health professionals since it fosters the organisational change, although it also has a slightly negative bureaucratisation effect on clinical practice.

Proceso de atención al paciente con urticaria aguda y crónica. Documento de consenso de la sección territorial andaluza de la Academia Española de Dermatología y Venereología / Clinical Pathway for Patients with Acute or Chronic Urticaria: A Consensus Statement of the Andalusian Section of the Spanish Academy of Dermatology and Venereology (AEDV)

La incorporación de nuevos fármacos al arsenal terapéutico, la actualización de las guías de práctica clínica y los hallazgos fisiopatológicos recientemente comunicados hacen que el manejo y conocimiento de la urticaria sea un tema de candente actualidad. La Sección territorial andaluza de la AEDV ha desarrollado un proceso de atención en el que se describen el recorrido del paciente, las características de calidad de las actuaciones y las recomendaciones para la toma de decisiones en los pacientes con urticaria. Presentamos un enfoque centrado en el paciente, y en el que se muestra su devenir en el sistema sanitario y la interrelación entre la atención primaria y hospitalaria, garantizando un punto clave, su continuidad asistencial

Attention has been focused on new ways to understand and manage urticaria ever since the recent addition of novel drugs to the therapeutic arsenal, the updating of clinical practice guidelines, and the publication of pathophysiologic insights. The Andalusian Section of the Spanish Academy of Dermatology and Venereology (AEDV) has developed a clinical pathway that defines quality-of-care characteristics and makes recommendations on decision-making affecting patients with urticaria. We present a patient-centered approach to care, in which the patient's clinical pathway through the health care system includes links between primary and hospital care to ensure continuity a key feature of quality

Proceso de atención a las personas con lesiones quísticas y tumorales benignas. Documento de consenso de la sección territorial andaluza de la Academia Española de Dermatología Médico-Quirúrgica y Venereología / Process of Care for Patients With Benign Cysts and Tumors: Consensus Document of the Andalusian Regional Section of the Spanish Academy of Dermatology and Venereology (AEDV)

Las lesiones cutáneas benignas representan un motivo de consulta frecuente, tanto en atención primaria como en las consultas de dermatología. Sin embargo, existe una amplia variabilidad en el acceso de los usuarios al diagnóstico y tratamiento de las lesiones cutáneas benignas, debido principalmente a que no se establecieron criterios explícitos y homogéneos para el abordaje de los pacientes con lesiones benignas. Con el objetivo principal de reducir la variabilidad en la atención a las personas con lesiones quísticas o tumorales benignas la Sección Territorial Andaluza de la AEDV ha desarrollado un proceso de atención en el que se describen el recorrido del paciente, las características de calidad de las actuaciones y las recomendaciones para la toma de decisiones en este tipo de lesiones

Benign skin lesions are a common reason for visits to primary care physicians and dermatologists. However, access to diagnosis and treatment for these lesions varies considerably between users, primarily because no explicit or standardized criteria for dealing with these patients have been defined. Principally with a view to reducing this variability in the care of patients with benign cysts or tumors, the Andalusian Regional Section of the Spanish Academy of Dermatology and Venereology (AEDV) has created a Process of Care document that describes a clinical pathway and quality-of-care characteristics for each action. This report also makes recommendations for decision-making with respect to lesions of this type

Process of Care for Patients With Benign Cysts and Tumors: Consensus Document of the Andalusian Regional Section of the Spanish Academy of Dermatology and Venereology (AEDV). / Proceso de atención a las personas con lesiones quísticas y tumorales benignas. Documento de consenso de la sección territorial andaluza de la Academia Española de Dermatología Médico-Quirúrgica y Venereología.

Benign skin lesions are a common reason for visits to primary care physicians and dermatologists. However, access to diagnosis and treatment for these lesions varies considerably between users, primarily because no explicit or standardized criteria for dealing with these patients have been defined. Principally with a view to reducing this variability in the care of patients with benign cysts or tumors, the Andalusian Regional Section of the Spanish Academy of Dermatology and Venereology (AEDV) has created a Process of Care document that describes a clinical pathway and quality-of-care characteristics for each action. This report also makes recommendations for decision-making with respect to lesions of this type.

Clinical Pathway for Patients with Acute or Chronic Urticaria: A Consensus Statement of the Andalusian Section of the Spanish Academy of Dermatology and Venereology (AEDV). / Proceso de atención al paciente con urticaria aguda y crónica. Documento de consenso de la sección territorial andaluza de la Academia Española de Dermatología y Venereología.

Attention has been focused on new ways to understand and manage urticaria ever since the recent addition of novel drugs to the therapeutic arsenal, the updating of clinical practice guidelines, and the publication of pathophysiologic insights. The Andalusian Section of the Spanish Academy of Dermatology and Venereology (AEDV) has developed a clinical pathway that defines quality-of-care characteristics and makes recommendations on decision-making affecting patients with urticaria. We present a patient-centered approach to care, in which the patient's clinical pathway through the health care system includes links between primary and hospital care to ensure continuity-a key feature of quality.

Higher vitamin D levels in HIV-infected out-patients on treatment with boosted protease inhibitor monotherapy.

OBJECTIVES: We investigated the vitamin D status of patients receiving frequently used types of combination antiretroviral therapy (cART), including boosted protease inhibitor (PI) monotherapy. METHODS: For this cross-sectional study, out of 450 HIV-infected patients followed in the Hospital Severo Ochoa (Madrid, Spain), we selected 352 patients for whom vitamin D levels had been measured (January 2009 to December 2010). We collected the following data: demographics, cART duration, main cART regimen, viral load (VL), CD4 cell count, and concentrations of 25(OH)-vitamin D [25(OH)-D], parathyroid hormone (PTH), albumin and calcium. Vitamin D status cut-off points were: (1) deficiency (vitDd): 25(OH)-D < 20 ng/mL; (2) insufficiency (vitDi): 25(OH)-D from 20 to 29.99 ng/mL; and (3) optimal (vitDo): 25(OH)-D ≥ 30 ng/mL. RESULTS: The percentages of patients with vitDd, vitDi and vitDo were 44, 27.6 and 28.5%, respectively. Twenty-nine out of 30 (96.7%) Black patients had vitDd or vitDi, vs. 71.6% in the global sample (P < 0.001). Former injecting drug users (IDUs) had a higher prevalence of vitDo (P < 0.001) than patients in other transmission categories. Among patients with vitDd, vitDi and vitDo, the proportions of patients with a VL ≤ 50 HIV-1 RNA copies/mL were 77.4, 68 and 91%, respectively (P < 0.0001). Of the cART regimens, only boosted PI monotherapy was associated with significant differences in vitamin D levels (P = 0.039). Multivariate logistic regression analysis showed an increased risk of vitDi or vitDd associated with the following variables: Black vs. Caucasian ethnicity [odds ratio (OR) 10.6; 95% confidence interval (CI) 1.2-94; P = 0.033]; heterosexual (OR 2.37; 95% CI 1.13-4.93; P = 0.022) or men who have sex with men (MSM) (OR 3.25; 95% CI 1.25-8.50; P = 0.016) transmission category vs. former IDU; and VL > 50 copies/mL (OR 2.56; 95% CI 1.10-7.25; P = 0.040). A lower risk of vitamin D insufficiency or deficiency was found in patients on boosted PI monotherapy vs. no treatment (OR 0.08; 95% CI 0.01-0.6; P = 0.018). CONCLUSIONS: Our data show an increased risk of vitamin D deficiency or insufficiency in patients with detectable VL and a Black ethnic background. Among cART regimens, boosted PI monotherapy was associated with a lower risk of vitamin D deficiency or insufficiency. The more favourable vitamin D status in former IDUs was probably attributable to a higher frequency of outdoor jobs in this group of patients.

Evaluación y aprendizaje del 27 Congreso de la Sociedad Española de Calidad Asistencial / Assessment and learning from the 27th Conference of the Spanish Society for quality in healthcare

Objetivo. Analizar los resultados del 27 Congreso de la Sociedad Española de Calidad Asistencial (SECA) celebrado en Sevilla (octubre de 2009). Material y método. Estudio descriptivo, retrospectivo, utilizando como fuente de información la base de datos de los comités del congreso. Población. Todas las comunicaciones recibidas (1.231). Evaluación de las comunicaciones por 36 parejas de evaluadores mediante criterios explícitos puntuables y asignación como experiencias o comunicaciones electrónicas. La satisfacción de los participantes en el congreso y en los talleres fue evaluada mediante un cuestionario anónimo. Resultados. Se aceptaron 1.213 comunicaciones. La puntuación media del total de comunicaciones aceptadas fue de 6,38±0,95 puntos. Las experiencias tienen una puntuación media de 7,55±0,41 puntos, mientras que las comunicaciones electrónicas tienen una puntuación media de 6,26±0,9 puntos. En cifras absolutas son Andalucía y Cataluña las comunidades autónomas que más comunicaciones presentaron (557 y 140, respectivamente) aunque, tras el cálculo de la tasa por millón de habitantes, la Región de Murcia (76,43) y Andalucía (67,91) obtuvieron las cifras más elevadas. Conclusiones. La evaluación de comunicaciones y la organización de un congreso de ámbito nacional son un proceso metodológicamente complejo. La rendición de cuentas de las acciones y decisiones realizadas por los Comités Organizador y Científico son un requisito ético de transparencia(AU)

Objective. To analyse the results of the 27th Conference of the Spanish Society for Quality in Health Care (SECA) held in Seville (October 2009). Material and methods. A retrospective descriptive study was conducted using the conference databases. Population. All abstracts received (1231). 36 pairs of reviewers using explicit criteria evaluated abstracts and assignment as Experiences or Electronic Communications. Participant satisfaction in the Conference and Workshops was evaluated by an anonymous questionnaire. Results. A total of 1213 communications were accepted. The average score of accepted abstracts was 6.38±0.95 points. Experiences had an average score of 7.55±0.41 points, while Electronic Abstracts had an average score of 6.26±0.9 points. Andalusia (557) and Catalonia (140) had the highest amount of abstracts in the Conference, but Murcia and Andalusia obtained the highest rates per million inhabitants. Conclusions. The assessment of abstracts and organising a national conference are methodologically complex processes. Accountability for actions and decisions made by the Organising and Scientific Committees are an ethical requirement of transparency(AU)

[Assessment and learning from the 27th Conference of the Spanish Society for quality in healthcare]. / Evaluación y aprendizaje del 27 Congreso de la Sociedad Española de Calidad Asistencial.

OBJECTIVE: To analyse the results of the 27th Conference of the Spanish Society for Quality in Health Care (SECA) held in Seville (October 2009). MATERIAL AND METHODS: A retrospective descriptive study was conducted using the conference databases. POPULATION: All abstracts received (1231). 36 pairs of reviewers using explicit criteria evaluated abstracts and assignment as Experiences or Electronic Communications. Participant satisfaction in the Conference and Workshops was evaluated by an anonymous questionnaire. RESULTS: A total of 1213 communications were accepted. The average score of accepted abstracts was 6.38 ± 0.95 points. Experiences had an average score of 7.55 ± 0.41 points, while Electronic Abstracts had an average score of 6.26 ± 0.9 points. Andalusia (557) and Catalonia (140) had the highest amount of abstracts in the Conference, but Murcia and Andalusia obtained the highest rates per million inhabitants. CONCLUSIONS: The assessment of abstracts and organising a national conference are methodologically complex processes. Accountability for actions and decisions made by the Organising and Scientific Committees are an ethical requirement of transparency.

Nutrición basada en la evidencia: presente, limitaciones y futuro / Evidence-based nutrition: present, limitations and future

La medicina basada en la evidencia (MBE) es, en la actualidad, la forma más fiable y segura de enfrentarse a la práctica clínica. Una de las definiciones más aceptadas recoge las 3 vertientes fundamentales de la MBE: las pruebas científicas, la experiencia clínica, y las necesidades y los valores del paciente. Desde su introducción en 1992, la MBE se ha aceptado, extendido e incluido en las distintas especialidades médicas, aunque también han aparecido importantes críticas y rechazos a su generalización así como dificultades en su aplicación. Entre los factores relacionados con nuestra dificultad de poner en marcha la estrategia de la MBE se encuentran la formación tradicional que hemos recibido como médicos, la enorme y desbordante cantidad de bibliografía científica publicada, y el tipo de fuentes que estamos acostumbrados a consultar ante los problemas diarios de la práctica clínica. Respecto a los argumentos más utilizados por sus críticos destacan la definición de reduccionista o simplista, y la poca importancia que, a su juicio, se presta a la experiencia clínica. Probablemente, y aunque sea difícil de reconocer, la característica de la MBE que más rechazo produce es la ausencia de una verdad universal y absoluta: las conclusiones a las que la MBE puede llegar siempre van precedidas de la descripción de la investigación primaria incluida y analizada; la aparición de nuevos resultados puede (y debe) modificar nuestra práctica clínica. Las revisiones sistemáticas de la bibliografía y las guías de práctica clínica, como instrumentos propios, facilitan la incorporación y el desarrollo de la MBE. La nutrición basada en la evidencia se encuentra, además de las limitaciones propias de la MBE, con una serie de problemas específicos relacionados fundamentalmente con las dificultades de diseño metodológico de los estudios, la poca evidencia científica disponible y las escalas de calidad y niveles de evidencia utilizados. Para comprender estos problemas es importante analizarlos de forma independiente en nutrición clínica y nutrición comunitaria, y abordar la primera separándola en sus 2 vertientes: la necesidad de alimentar-mantener el estado nutricional, y la utilización de la nutrición como arma terapéutica-fármaco, capaz de modificar por sí misma la evolución de una enfermedad. A lo largo de este trabajo se revisan los conceptos, las aplicaciones y las limitaciones de la MBE y de su aplicación en el campo de la nutrición (AU)

Evidence-based medicine (EBM) is currently the safest and most reliable way to practice clinical medicine. One of the most widely accepted definitions includes the three main principles of EBM: scientific evidence, clinical experience and the needs and values of the patient. Since its introduction in 1992, EBM has been incorporated into the various medical specialties, although major criticisms and obstacles to its generalization have also appeared. Among the factors involved in our difficulty in implementing EBM are our traditional training as physicians, the sheer quantity of scientific literature published and the type of sources that we are used to consulting when faced with the problems of daily clinical practice. The most frequent arguments leveled against EBM are that it is reductionist or simplistic and, according to its critics, that it gives scant importance to clinical experience. Although it is difficult to admit, the characteristic of EBM that probably arouses the strongest criticism is the absence of a universal and absolute truth: the conclusions that can be reached through EBM are always preceded by a description of the main investigation analyzed; new results can (and should) modify our clinical practice. Systematic reviews of the literature and clinical practice guidelines, as instruments by themselves, facilitate the implementation and development of EBM. In addition to the limitations of EBM, evidence-based nutrition (EBN) faces a series of specific problems mainly related to the difficulties of study designs, the scarce scientific evidence available, and the quality scales and levels of evidence used. To understand these problems, they should be analyzed independently in clinical nutrition and community nutrition, while clinical nutrition should be approached by separating it into its two branches: the need to feed-maintain nutritional status, and the use of nutrition as a therapeutic modality capable of modifying the course of a disease. The present article reviews the concepts, applications and limitations of EBN and its applications in the field of nutrition. "Half of what we teach them will be proved to be false in the next 10 years. The problem is that none of their teachers know which half this will be". Dr. Sydney Burwell, Dean of the Faculty of Medicine of Harvard University (Taken from "Sackett DL., Straus ShE., Richardson WS, Rosenberg W, Haynes RB. Evidence Based Medicine. How to Practice and Teach. Churchill Livingstone. Edinburgh 2000 (2nd edition) (AU)

[Fiber in enteral nutrition: systematic review of the literature]. / La fibra en nutrición enteral: revisión sistemática de la literatura.

UNLABELLED: It has been suggested that adding fibre to enteral nutrition (EN) formulas may achieve a normalization of the gastrointestinal tract's functions by reducing the incidence of diarrhoea and constipation. However, this supposition is based on the demonstrated effect of fibre in natural feeding. There have so far been no firm recommendations on the use, amount or type of fibre that is most advisable in EN. GOAL: To establish the scientific evidence existing on the benefits gained by adding fibre to EN formulas compared with the use of fibre-free formulas. MATERIAL AND METHODS: Bibliographical search on PubMed, on the register of Randomized Prospective Trials (RPT) of the Cochrane Library and manual search. INCLUSION CRITERIA: RPT comparing fibre-free formulas with isocaloric ad isonitrogen formulas containing fibre in total EN. Four independent reviewers revised the references selected. The data were analyzed using the RevMan 4.1 programme from the Cochrane Library. RESULTS: Of 286 references, 25 fulfilled the inclusion criteria. The data were grouped by population and outcome variable. The addition of fermentable fibre to the EN formulas tends to reduce the incidence of diarrhoea in critically-ill and post-surgery patients (OR = 0.66; 95% CI 0.46-0.95; p = 0.19). The use of formulas with insoluble fibre seems to increase the frequency of depositions and reduce the need for laxatives in immobilized patients receiving long-term EN but the data are insufficient. In people with normal gastrointestinal functions, the frequency of depositions is similar when using formulas with and without fibre (DPM = -0.97; 95% CI -0.12-[-0.02]; p < 0.0001). CONCLUSION: There is currently insufficient evidence to recommend the systematic use of formulas containing fibre in total EN. However, in critically-ill and post-surgery patients, the use of formulas with fermentable fibre tends to reduce the incidence of diarrhoea. Although information is still lacking. The formulas with insoluble fibre seem to diminish constipation in chronic EN, whereas in other situations where the digestive system is working appropriately, no benefit has been shown. It is necessary to increase the number and quality of these trials in order to be able to establish firm recommendations on the use of EN formulas containing fibre.

La fibra en nutrición enteral: revisión sistemática de la literatura / Fibre in enteral nutrition: systematic review of the literature

Se ha sugerido que añadir fibra a las fórmulas de nutrición enteral (NE) consigue una normalización del funcionamiento del tracto gastrointestinal, disminuyendo la incidencia de diarrea y de estreñimiento. Sin embargo, esta suposición está basada en el efecto demostrado de la fibra en la alimentación natural. Hasta la fecha no existen recomendaciones firmes sobre el uso, la cantidad ni el tipo de fibra más aconsejable en NE. Objetivo: Establecer la evidencia científica que existe sobre el beneficio de la adición de fibra a las fórmulas de NE comparado con el uso de fórmulas sin fibra. Material y métodos: Búsqueda bibliográfia en PubMed, en el registro de Estudios Prospectivos Aleatorizados (EPA) de la Biblioteca Cochrane y búsqueda manual. Criterio de inclusión: EPA que comparen fórmulas sin fibra con fórmulas isocalóricas e isonitrogenadas con fibra en NE total. Cuatro revisores independientes revisan las referencias seleccionadas. Para el análisis de los datos se utiliza el programa RevMan 4.1 de la Biblioteca Cochrane. Resultados: De 286 referencias 25 cumplen el criterio de inclusión. Los datos se agrupan por población y por variable de resultado. La adición de fibra fermentable a las fórmulas de NE tiende a disminuir la incidencia de diarrea en pacientes críticos y postquirúrgicos (OR = 0,66; IC 95 por ciento 0,46-0,95; p = 0,19). El uso de fórmulas con fibra insoluble parece aumentar la frecuencia de deposiciones y disminuir la necesidad de laxantes en pacientes inmovilizados con NE a largo plazo pero los datos son insuficientes. En personas con función gastrointestinal normal la frecuencia de las deposiciones es similar usando fórmulas con y sin fibra (DPM = 0,07; IC 95 por ciento -0,12-0,02, p < 0,0001). Conclusión: En la actualidad no existe suficiente evidencia para recomendar el uso sistemático de fórmulas con fibra en NE total. No obstante, en pacientes críticos y postquirúrgicos la utilización de fórmulas con fibra fermentable tiende a reducir la incidencia de diarrea. Aunque todavía faltan datos, las fórmulas con fibra insoluble parecen disminuir el estreñimiento en NE crónica, mientras que en otras situaciones, cuando el tubo digestivo funciona adecuadamente, no se ha demostrado beneficio. Es necesario aumentar el número y calidad de los estudios antes de poder establecer recomendaciones firmes sobre el uso de fórmulas de NE con fibra (AU)

It has been suggested that adding fibre to enteral nutrition (EN) formulas may achieve a normalization of the gastrointestinal tract's functions by reducing the incidence of diarrhoea and constipation. Howerver, this supposition is based on the demonstrated effect of fibre in natural feeding. There have so far been no firm recommendations on the use, amount or type of fibre that is most advisable in EN. Goal: To establish the scientific evidence existing on the benefits gained by adding fibre to EN formulas compared with the use of fibre-free formulas. Material and methods:Bibliographical search on PubMed, on the register of Randomized Prospective Trials (RPT) of the Cochrane Library and manual search. Inclusion criteria: RPT comparing fibre-free formulas with isocaloric ad isonitrogen formulas containing fibre in total EN. Four independent reviewers revised the references selected. The data were analyzed using the RevMan 4.1 programme from the Cochrane Library. Results: Of 286 references, 25 fulfilled the inclusion criteria. The data were grouped by population and outcome variable. The addition of fermentable fibre to the EN formulas tends to reduce the incidence of diarrhoea in critically-ill and post-surgery patients (OR = 0.66; 95% CI 0.46-0.95; p = 0.19). The use of formulas with insoluble fibre seems to increase the frequency of depositions and reduce the need for laxatives in immobilized patients receiving long-term EN but the data are insufficient. In people with normal gastrointestinal functions, the frequency of depositions is similar when using formulas with and without fibre (DPM = -0.97; 95% CI -0.12-[-0.02]; p < 0.0001). Conclusion: There is currently insufficient evidence to recommend the systematic use of formulas containing fibre in total EN. However, in critically-ill and post-surgery patients, the use of formulas with fermentable fibre tends to reduce the incidence of diarrhoea. Although information is still lacking. The formulas with insoluble fibre seem to diminish constipation in chronic EN, whereas in other situations where the digestive system is working appropriately, no benefit has been shown. It is necessary to increase the number and quality of these trials in order to be able to establish firm recommendations on the use of EN formulas containing fibre (AU)

Intoxicacion aguda acuosa / Acute water intoxication

No disponible

[Acute water intoxication as complication of intravenous urography]. / Intoxicación aguda acuosa como complicación de una urografía intravenosa.

Physiologically, two complementary mechanisms regulate plasma osmolality: antduretic hormone ADH) and thirst. ADH release s supressed, thirst s inhbted and renal water loss occurs when plasma osmolality below a threshold level. The rise in plasma osmolalty causes ADH release, stimulation of thirst and water intake. Acute water intoxication is exceptional in patients without a chronic psychiatric disease. Herein, we describe a case of acute water intoxication in a previously healthy patient, after making an intravenous urography. The excessive water intake and the impossibility of renal water loss because of streee-induced ADH release originated t. Only nine cases have been previously described; almost they all were women preparing for diagnostic procedures.

Intoxicación aguda acuosa como complicación de una urografía intravenosa / Acute water intoxication as a complication of intravenous urography

En circunstancias fisiológicas la osmolalidad plasmática se regula por dos mecanismos complementarias: la hormona antidiurética (ADH) y la sed. Cuando se produce una disminución de la osmolalidad por incremento del agua en el organismo se inhibe la sensación de sed y la secreción de ADH, siendo el exceso de agua eliminado por el riñón. Cuando aumenta la osmolalidad se libera ADH, que disminuye la pérdida de agua por el riñón, y aparece la sed, produciendo ingreso de agua por vía digestiva.La intoxicación acuosa aguda es excepcional en personas sin patología psiquiátrica crónica. Presentamos un caso de intoxicación acuosa aguda durante la realización de una urografía intravenosa. La intoxicación se produjo por una ingesta acuosa excesiva junto con la liberación de ADH por estrés psicológico, que impidió la eliminación de agua por el riñón.De los 9 casos semejantes previamente descritos, la mayoría han sido en mujeres y en el contexto de la preparación de pruebas diagnósticas. (AU)

IGF-1 and its binding proteins IGFBP-1 and 3 as nutritional markers in prepubertal children.

OBJECTIVE: To assess the validity of the use of IGF-1, IGFBP-1 and IGFBP-3 as biochemical markers of nutritional status in prepubertal healthy children. DESIGN: Cross-sectional survey. SETTING: Healthy children from the Madrid area. PARTICIPANTS: Prepubertal children (aged 7-10 years) with a body mass index (BMI) above the 90th percentile (n = 25) and below the 10th percentile (n = 31) were selected from 2,559 included in the CAENPE study (Food Intake and Nutritional Status in Schoolchildren from Madrid). RESULTS: Overweight children were found to have higher serum levels of IGF-1 (306+/-162.2 vs. 209+/-71.2 ng/ml, p<0.001) and IGFBP-3 (3.3+/-1.0 vs. 2.9+/- 0.5 mg/l, p<0.01) and lower serum levels of IGFBP-1 (4.3+/-3.9 vs. 13.8+/-7.4 microg/l, p<0.01). There was a positive correlation with BMI, for IGF-1 and IGFBP-3, and negative correlation for IGFBP-1. No differences in albumin and transferrin concentrations were observed between both groups of children. CONCLUSION: IGF-1, IGFBP-1 and IGFBP-3 clearly classify over- and underweight prepubertal children, showing a good correlation with BMI. They can be used as biochemical markers of caloric nutritional status in this population.

Tasa de incidencia y características del cáncer de tiroides en un área de la zona Sur de Madrid / Rate of incidence and characteristics of thyroid cancer in an area in the south of Madrid, Spain

Se confirma un aumento del cáncer de tiroides en nuestra área, especialmente de origen folicular. Desafortunadamente, no podemos extraer conclusiones respecto a su etiología. Este estudio realza la importancia de realizar más investigaciones para esclarecer este tema. (AU)