[Research lines proposed by Andalusian Association of Community Nursing]. / Líneas de investigación propuestas por la Asociación de Enfermería Comunitaria de Andalucía.

OBJECTIVE: To define and prioritise the future research lines of the Andalusian Association of Community Nursing (ASANEC). METHOD: Application of the Delphi technique within the members of the Working Group of the Research area of ASANEC, consisting of Community nurses from clinical and educational settings, as regards research in seven Andalusian provinces. Three rounds of participation were performed, with the last one being prioritised using a Linear Scale. Averages and standard deviations have been calculated. RESULTS: The total number of participants on this technique was 13 professionals (54.16%). The main research lines finally agreed and prioritised, were the following, in decreasing order: «care management¼, «quality of life¼, «lifestyles and health education in children and adolescent population¼, «design and validation of nursing assessment tools¼, «patient safety¼, «accessibility to healthcare services and development of self-care capacity¼. CONCLUSIONS: Research on the new model of care management introduced into Andalusian primary care was given priority, although there are more emerging research lines related to Health Promotion and Prevention of Health problems in the general population, children, young people and vulnerable populations. These results have been the deciding factors in the choice of the current research lines developed by the ASANEC Research Group.

[Use of sirolimus-eluting stents in complex lesions: clinical and angiographic follow-up]. / Utilización del stent recubierto de rapamicina en la revascularización de lesiones complejas: estudio con seguimiento clínico y angiográfico.

INTRODUCTION AND OBJECTIVES: The RAVEL and SIRIUS studies have demonstrated important reductions in clinical and angiographic restenosis in lesions treated with sirolimus-eluting stents. However, inclusion criteria in both studies excluded complex lesions. We studied immediate and long-term results with this stent in these complex lesions. PATIENTS AND METHOD: Prospective, observational study with clinical and angiographic follow-up of patients who met the exclusion criteria used in the RAVEL and SIRIUS studies. All patients were treated in our catheterization laboratory between June 2002 and April 2003 with the Cypher stent, and 57 patients (68 lesions) were studied in all. The most frequent lesion characteristics were excessive length 26.5%; ostial lesions 25%, bifurcations 23.5%, and severe calcifications 22.1%. Almost half (47%) of the patients had diabetes and 68% had multivessel disease. RESULTS: PTCA was successful in all patients. There was one major adverse cardiovascular event (MACE) before discharge (1 acute Q-wave myocardial infarction). Two episodes of subacute thrombosis occurred during the first week. During long-term clinical follow-up (8.7 [3.1] months) of all patients, there were 4 MACE (7%): 1 cardiac death, 1 acute myocardial infarction and 2 revascularizations of the target vessel. Intersegmental restenosis was observed by angiography in 4 lesions (8%). CONCLUSIONS: Implantation of the Cypher stent in complex lesions is safe and is associated, after 6 months of follow-up, with a low incidence of clinical events and a very low percentage of angiographic restenosis.

Utilización del stent recubierto de rapamicina en la revascularización de lesiones complejas: estudio con seguimiento clínico y angiográfico / Use of Sirolimus-Eluting stents in complex lesions: Clinical and angiographic follow-up

Introducción y objetivos. Los estudios RAVEL y SIRIUS han demostrado una importante reducción de la reestenosis clínica y angiográfica en lesiones tratadas con stent recubierto de rapamicina. Sin embargo, los criterios de selección de ambos ensayos clínicos excluyeron lesiones complejas. Estudiamos los resultados inmediatos y a medio plazo del stent de rapamicina en este tipo de lesiones complejas. Pacientes y método. Estudio prospectivo y observacional con seguimiento clínico y angiográfico de pacientes tratados en nuestro servicio entre junio de 2002 y abril de 2003 con el stent Cypher que cumplían criterios de exclusión en los estudios RAVEL y SIRIUS. Se estudió a 57 pacientes (68 lesiones). Las características más frecuentes fueron: longitud excesiva en el 26,5 por ciento, lesiones ostiales en el 25 por ciento, bifurcaciones en el 23,5 por ciento y calcificación severa en el 22,1 por ciento. El 47 por ciento de los pacientes era diabético y el 68 por ciento presentaba enfermedad multivaso. Resultados. La angioplastia coronaria transluminal percutánea se llevó a cabo con éxito en todos los casos. Hubo un evento cardíaco mayor durante el ingreso hospitalario (un infarto agudo de miocardio con onda Q) y 2 trombosis subagudas en la primera semana. Se realizó seguimiento clínico a medio plazo (8,7 ñ 3,1 meses) en el 100 por ciento de los pacientes y acontecieron 4 eventos cardíacos mayores (7 por ciento): una muerte cardíaca, un infarto agudo de miocardio y 2 revascularizaciones del vaso diana. Se objetivó reestenosis angiográfica intrasegmentaria en 4 lesiones (8 por ciento). Conclusiones. El implante del stent Cypher en lesiones complejas es seguro y se acompaña de una baja incidencia de eventos clínicos y muy bajo porcentaje de reestenosis angiográfica en el seguimiento a los 6 meses (AU)