Clinical and financial implications of hospital malnutrition in Spain.

OBJECTIVE: The aim of this review is to analyse the studies about cost and clinical implications that malnutrition causes in the Spanish hospitals. MATERIAL AND METHODS: The review of the literature was carried out through a bibliographic search in Web of Science following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria and analyse the cost of treatment of malnourished and anorexia nervosa (AN) patients RESULTS: Seventeen studies with economic data related to malnutrition were included. The employment of a nutritional screening is the first tool to determinate the prevalence. Malnutrition is related to an incremental cost due to a longer hospital stay, expensive treatment, and higher rate of readmissions. Malnourished patients present more clinical complications, more infections, and higher mortality. No studies were found with economic data of AN in Spain. CONCLUSIONS: The prevalence of malnutrition is over 20%, with the elderly patients being the most affected. Nutritional screening is not implanted in all Spanish hospitals in spite of its proven cost-effectiveness. The cost and the clinical implications of malnutrition make this disease a health national problem. The knowledge of the real cost of AN treatment would increase the interest of public institutions on the development of specific Nutritional Screening tools for an early detection of AN.

Leiomiomatosis intravascular / Intravascular leiomyomatosis

Los leiomiomas son las neoplasias uterinas más frecuentes en las mujeres, están presentes en el 20 - 30% de las pacientes mayores de 30 años y se encuentran en el 75% de las histerectomías. Estos tumores poseen receptores de estrógenos y progesterona y su crecimiento está influenciado por niveles hormonales. En raras ocasiones, estos tumores pueden tener una extensión intravascular a partir de las venas uterinas. A pesar de que histológicamente se trata de un tumor benigno, se puede considerar agresivo, ya que tiene altos índices de recurrencia y puede tener consecuencias fatales, ya sea por su capacidad de metastatizar o por la invasión vascular, que aunque es muy poco frecuente, puede extenderse a través de las venas gonadales e ilíacas hasta la vena cava inferior y llegar hasta las cavidades cardiacas, donde produce obstrucción al flujo sanguíneo, altera la dinámica valvular de manera severa y favorece el desarrollo de embolismo pulmonar. Cuando esto ocurre la presentación clínica puede ser muy variable e inconstante; desde muerte súbita, extrasístoles, taquicardia, síncope, disnea e insuficiencia cardiaca derecha En otras ocasiones puede ser asintomático y diagnosticarse únicamente mediante la necropsia (AU)

Uterine leiomyomas are the most common tumors in women and are found in 20-30% of patients older than 30 years and in 75% of hysterectomies. These tumors have estrogen and progesterone receptors and their growth is influenced by hormone levels. Although histologically benign, uterine leiomyomas can be considered aggressive due to their high recurrence index and life-threatening consequences, whether due to metastases or vascular invasion. Although vascular invasion is extremely rare, these tumors can spread through the gonadal veins to the iliac and inferior vena cava and reach the heart cavities. At this site, the infiltration causes blood flow obstruction and severe alterations in vascular dynamics and favors the development of pulmonary embolism. When this occurs, the clinical presentation can be highly variable and inconsistent, ranging from sudden death, extrasystoles, tachycardia, syncope, dyspnea and right heart failure. On other occasions, these tumors can be asymptomatic and diagnosed only by autopsy (AU)

Efficacy of an adverse drug reaction electronic reporting system integrated into a hospital information system.

BACKGROUND: Adverse drug reaction (ADR) spontaneous reporting is the primary method of postmarketing drug surveillance; although it is an important part of postmarketing drug surveillance, it is underused. Before 2004, almost no ADRs were reported in our 400-bed hospital. As an electronic hospital information system was available in our hospital, we developed a tool (ADR-RS-IHIS) for ADR reporting integrated into the hospital information system to facilitate reporting through easy use, automatic input of certain information, increased accessibility, real-time review, and intervention. OBJECTIVE: To analyze the efficacy of the ADR-RS-IHIS in increasing ADR reporting to the national drug surveillance system, propose and implement improvements to increase ADR reporting, and evaluate the impact of these improvements. METHODS: Every ADR reported through the ADR-RS-IHIS was evaluated retrospectively. Two study phases for evaluating ADR-RS-IHIS efficacy were identified. Phase I took place April 2004-August 2006; in April 2006, an interim analysis was performed to propose improvements. Phase II took place September 2006-April 2007 for evaluation of the impact made by the proposed improvements. Efficacy in the phase I and improvement impact on phase II were measured as the number of ADRs reported to the national drug surveillance system. RESULTS: The rate of ADRs reported per month to the national system increased from 0 before 2004 to 0.91 in phase I and 1.62 in phase II (2.25 if delayed reporting was considered). Improvement measures included: allowing nurses to report ADRs in the same way as physicians and pharmacists, automatic form filling of certain information from the electronic hospital information system, easier ADR report analysis, and automatic notification to the allergy department regarding suspected allergies. CONCLUSIONS: An ADR reporting system integrated into the electronic hospital information system is effective for increasing the number of ADRs reported to the national drug surveillance system. Allowing nurses to report ADRs in a manner similar to that of physicians and pharmacists, as well as automatic entry of certain data into the form, contributes to the improvement of the system.

Phase I trial of intratumoral injection of an adenovirus encoding interleukin-12 for advanced digestive tumors.

PURPOSE: To evaluate the feasibility and safety of intratumoral injection of an adenoviral vector encoding human interleukin-12 genes (Ad.IL-12) and secondarily, its biologic effect for the treatment of advanced digestive tumors. PATIENTS AND METHODS: Ad.IL-12 was administered in doses ranging from 2.5 x 10(10) to 3 x 10(12) viral particles, to seven cohorts of patients with advanced pancreatic, colorectal, or primary liver malignancies. Patients were thoroughly assessed for toxicity, and antitumor response was evaluated by imaging techniques, tumor biopsy, and hypersensitivity skin tests. Patients with stable disease and no serious adverse reactions were allowed to receive up to 3 monthly doses of Ad.IL-12. RESULTS: Twenty-one patients (nine with primary liver, five with colorectal, and seven with pancreatic cancers) received a total of 44 injections. Ad.IL-12 was well tolerated, and dose-limiting toxicity was not reached. Frequent but transient adverse reactions, including fever, malaise, sweating, and lymphopenia, seemed to be related to vector injection rather than to transgene expression. No cumulative toxicity was observed. In four of 10 assessable patients, a significant increase in tumor infiltration by effector immune cells was apparent. A partial objective remission of the injected tumor mass was observed in a patient with hepatocellular carcinoma. Stable disease was observed in 29% of patients, mainly those with primary liver cancer. CONCLUSION: Intratumoral injection of up to 3 x 10(12) viral particles of Ad.IL-12 to patients with advanced digestive malignancies is a feasible and well-tolerated procedure that exerts only mild antitumor effects.