Initial results of endourological treatment of renoureteral lithiasis by means of flexible ureteroscopy and percutaneous surgery in an outpatient procedure in a tertiary care center.

OBJECTIVE: Urinary lithiasis is a prevalent disease with a high socioeconomic impact, where endourological surgery has shown excellent results with minimal complications. For its part, outpatient surgery is an efficient, safe and quality care model. We present our experience in the outpatient endourological treatment of lithiasis and a review of the main series. MATERIAL AND METHODS: Prospective analysis of 85 flexible or percutaneous procedures for the treatment of lithiasis, carried out in our center between January 2021 and April 2022. The main objective was to analyze the rate of unplanned admission and the success and incidence of complications as secondary objectives. The patients were selected following the inclusion criteria of the care process. RESULTS: The mean age was 56 ± 14 years. Urine culture was positive in 13.9% of the patients, 38% had a pre-surgical double-J catheter. Median stone surface was 55 mm 2 (961 ± 323 Hounsfield Units). 73 flexible and 12 percutaneous procedures were performed. 8 patients required immediate unplanned admission and another 2 during the first month. 94% were stone-free at the third month. No intraoperative complications were detected, although 16.5% of the patients presented some type of postoperative complication. CONCLUSION: In our experience, with a strict selection of patients and following a care process with multidisciplinary participation, endourological procedures are feasible and safe in the outpatient setting. Periodic monitoring of the results is essential for the sake of a constant improvement of the process.

Resultados iniciales del tratamiento endourológico de la litiasis renoureteral mediante ureteroscopia flexible y cirugía percutánea en régimen de cirugía mayor ambulatoria en un centro de tercer nivel / Initial results of endourological treatment of renoureteral lithiasis by means of flexible ureteroscopy and percutaneous surgery in an outpatient procedure in a tertiary care center

Objetivo La litiasis urinaria es una enfermedad prevalente y con elevado impacto socioeconómico, donde la cirugía endourológica ha demostrado excelentes resultados con mínimas complicaciones. Por su parte, la cirugía ambulatoria es un modelo asistencial eficiente, seguro y de calidad. Presentamos nuestra experiencia en el tratamiento endourológico ambulatorio de la litiasis renoureteral y una revisión de las principales series. Material y métodos Análisis prospectivo de 85 procedimientos flexibles o percutáneos para el tratamiento de la litiasis, llevados a cabo en nuestro centro entre enero de 2021 y abril de 2022. Se estableció como objetivo principal analizar la tasa de ingreso no planificado y como objetivos secundarios el éxito e incidencia de complicaciones. Los pacientes fueron seleccionados siguiendo los criterios del proceso asistencial. Resultados La edad media fue de 56±14 años. El urocultivo fue positivo en 13,9% de los pacientes, siendo portadores de doble J prequirúrgico 38%. Mediana de superficie litiásica de 55 mm2, con 961±323 Unidades Hounsfield. Se realizaron 73 procedimientos flexibles y 12 percutáneos. Ocho pacientes requirieron ingreso no planificado inmediato y otros dos durante el primer mes. Al tercer mes, 94% se encontraban libre de litiasis. No se detectaron complicaciones intraoperatorias, aunque 16,5% de los pacientes presentaron algún tipo de complicación postoperatoria. Conclusión En nuestra experiencia, con una estricta selección de los pacientes y siguiendo un proceso asistencial con participación multidisciplinar, los procedimientos endourológicos son factibles y seguros en el ámbito ambulatorio. La monitorización periódica de los resultados es fundamental en aras de una mejora constante del proceso (AU)

Objective Urinary lithiasis is a prevalent disease with a high socioeconomic impact, where endourological surgery has shown excellent results with minimal complications. For its part, outpatient surgery is an efficient, safe and quality care model. We present our experience in the outpatient endourological treatment of lithiasis and a review of the main series. Material and methods Prospective analysis of 85 flexible or percutaneous procedures for the treatment of lithiasis, carried out in our center between January 2021 and April 2022. The main objective was to analyze the rate of unplanned admission and the success and incidence of complications as secondary objectives. The patients were selected following the inclusion criteria of the care process. Results The mean age was 56±14 years. Urine culture was positive in 13.9% of the patients, 38% had a pre-surgical double-J catheter. Median stone surface was 55 mm2 (961±323 Hounsfield Units). 73 flexible and 12 percutaneous procedures were performed. 8 patients required immediate unplanned admission and another 2 during the first month. 94% were stone-free at the third month. No intraoperative complications were detected, although 16.5% of the patients presented some type of postoperative complication. Conclusion In our experience, with a strict selection of patients and following a care process with multidisciplinary participation, endourological procedures are feasible and safe in the outpatient setting. Periodic monitoring of the results is essential for the sake of a constant improvement of the process (AU)

[Expert opinion on strategies to improve vaccination coverage against seasonal influenza]. / Documento de opinión de expertos para la mejora de la cobertura vacunal frente a la gripe estacional.

Seasonal flu continues to be a major public health concern, and the influenza vaccine remains the most effective preventive measure. In Spain, vaccination coverage data from previous seasons show vaccination rates well below official targets; however, these figures improved significantly after the COVID-19 pandemic. Given the importance of achieving and maintaining high vaccination rates in order to avoid the clinical and economic impact of influenza, our multidisciplinary group of experts on vaccines analyzed the impact of low vaccination rates in Spain and drafted a series of measures to boost influenza vaccination coverage, particularly among priority groups.

[Health literacy in patients with type 2 diabetes: A cross-sectional study using the HLS-EU-Q47 questionnaire]. / Alfabetización en salud en pacientes con diabetes tipo 2: un estudio transversal con el cuestionario HLS-EU-Q47.

OBJECTIVE: The aim of this study was to determine the level of health literacy of diabetic patients aged 50 to 75 years, from Ourense, Spain, as well as its relationship with the glycated haemoglobin (HbA1c) concentration and cardiovascular risk of the patient. MATERIAL AND METHODS: Cross-sectional study using a self-completed questionnaire. From a multi-stage sampling, urban, type 2 diabetic patients were randomly included. The level of health literacy, using the HLS-EU-Q47 questionnaire, the last concentration of HbA1c, and both total and fatal cardiovascular risk at 10 year follow-up, measured using the UKPDS (U.K. Prospective Diabetes Study) algorithm, were determined. The age, gender, level of education, level of social support, social class, and comorbidities were used as covariates. RESULTS: A total of 103 patients were analysed. Out of all the patients, 81.5% (84) had an unsuitable health literacy level (29.1% had an inadequate level and 52.4% had a problematic level). A clear association was seen between a higher level of health literacy and higher levels of education. Moreover, the level of health literacy was seen to be inversely related to the level of control of the patients' diabetes measured on the basis of their HbA1c (P=.03) concentration. However, no such association was found with the cardiovascular risk (P=.3). CONCLUSIONS: The results of the present study show that the level of literacy of the analysed population was insufficient, and that its improvement could result in a better outcome in the treatment of diabetic patients.

Selection of reliable reference genes for RT-qPCR studies in Octopus vulgaris paralarvae during development and immune-stimulation.

The common octopus, Octopus vulgaris is a new candidate species for aquaculture. However, rearing of octopus paralarvae is hampered by high mortality and poor growth rates that impede its entire culture. The study of genes involved in the octopus development and immune response capability could help to understand the key of paralarvae survival and thus, to complete the octopus life cycle. Quantitative real-time PCR (RT-qPCR) is the most frequently tool used to quantify the gene expression because of specificity and sensitivity. However, reliability of RT-qPCR requires the selection of appropriate normalization genes whose expression must be stable across the different experimental conditions of the study. Hence, the aim of the present work is to evaluate the stability of six candidate genes: ß-actin (ACT), elongation factor 1-α (EF), ubiquitin (UBI), ß-tubulin (TUB), glyceraldehyde 3-phosphate dehydrogenase (GADPH) and ribosomal RNA 18 (18S) in order to select the best reference gene. The stability of gene expression was analyzed using geNorm, NormFinder and Bestkeeper, in octopus paralarvae of seven developmental stages (embryo, paralarvae of 0, 10, 15, 20, 30 and 34days) and paralarvae of 20days after challenge with Vibrio lentus and Vibrio splendidus. The results were validated by measuring the expression of PGRP, a stimuli-specific gene. Our results showed UBI, EF and 18S as the most suitable reference genes during development of octopus paralarvae, and UBI, ACT and 18S for bacterial infection. These results provide a basis for further studies exploring molecular mechanism of their development and innate immune defense.

Increasing rates in Clostridium difficile infection (CDI) among hospitalised patients, Spain 1999-2007.

Limited information is available on the burden and epidemiology of Clostridium difficile infection (CDI) in Spain. The present report communicates the secular trends in prevalence of CDI among hospitalised patients in Spain from 1999 through 2007. Data were obtained through the EPINE study (Estudio de prevalencia de las infecciones nosocomiales en los hospitales españoles), a point prevalence study series of nosocomial infections among patients admitted to hospital in Spain. A total of 378 cases with CDI were identified. Median age was 74 years. Prevalence rates of CDI increased from 3.9 to 12.2 cases per 10,000 hospitalised patients and showed a significantly increasing secular trend from 1999 through 2007 (prevalence rate ratio per each year increment 1.09; 95% CI 1.05 - 1.14). Percentage of hospitalised patients receiving antimicrobials increased linearly from 36.0% in 1999 to 40.7% in 2007 (p <0.001) and was strongly correlated to CDI prevalence (R square = 0.73; regression coefficient =1.194, 95% CI= 1.192 - 1.196).

Meat and fish consumption and risk of lung cancer: A case-control study in Galicia, Spain.

Diet is one of the elements that may influence the development of lung cancer. To ascertain the relationship between meat and fish consumption and the appearance of this disease, a case-control study was conducted on a population in Galicia (NW Spain), with a sample of 295 cases and 322 controls. All cases had histologic confirmation, and controls were individuals who were attending the hospital to undergo trivial surgery. All subjects were over 35, and sampling was based on sex frequency. Frequent consumption of meat seemed to have a protective effect, with an OR of 0.24 (95% CI 0.11-0.50), an effect that was maintained for pork consumption (OR 0.35; 95% CI 0.18-0.67). In contrast, consumption of fish showed an association with lung cancer, with an OR of 1.67 (95% CI 0.99-2.81), an association that extended to both white (OR 1.61 95% CI 0.93-2.79) and blue fish (OR 2.03 95% CI 1.23-3.34). Consumption of meat seems to reduce the risk of lung cancer, whereas consumption of fish could exert an influence by increasing the risk of this disease.

Influence of pharmacists' attitudes on adverse drug reaction reporting : a case-control study in Portugal.

INTRODUCTION: Pharmacists can play a fundamental role in adverse drug reaction (ADR) reporting, although the factors that affect underreporting among these professionals are unknown. The objectives of this study were to identify (i) professional or demographic characteristics; and (ii) attitudes associated with pharmacists' ADR reporting in northern Portugal. METHODS: We conducted a case-control study on a population of pharmacists employed in hospital and community pharmacies across Portugal's Northern Regional Health Authority catchment area in 2003. Cases (n=34) comprised pharmacists who had reported at least one ADR to the northern region's drug surveillance unit, and controls (n=280) were randomly sampled from pharmacists who had never reported an ADR. All were interviewed using a mail questionnaire. Most attitudes were based on Inman's 'seven deadly sins' and were measured using a continuous visual analogue scale. Answers were recorded in a range from 0 (total disagreement) to 10 (total agreement). Logistic regression was used to determine the ADR reporting adjusted odds ratio (OR) for a change in exposure corresponding to the interquartile range for each attitude. RESULTS: The response rate was 86.8%. Reporting probability proved higher among hospital versus community pharmacists (adjusted OR 20.0; 95 CI 3.3, 125.0; p<0.001). Attitudes to ADRs were strongly associated with reporting probability. Hence, an interquartile decrease in any of the following attitudes increased the probability of reporting by (i) 223% (95% CI 51, 595; p < 0.05) for "Really serious ADRs are well documented by the time a drug is marketed"; (ii) 240% (95% CI 89, 508; p=0.002) for "I would only report an ADR if I were sure that it was related to the use of a particular drug"; (iii) 316% (95% CI 44, 1104; p=0.010) for "It is only necessary to report serious or unexpected ADRs"; and (iv) 171% (95% CI 13, 549; p=0.020) for "I do not have time to think about the involvement of the drug or other causes in ADRs". CONCLUSIONS: ADR under-reporting is strongly associated with certain attitudes, possibly indicating that under-reporting could be minimised through educational interventions targeted at changing such attitudes. Pharmacists' ADR education must be improved and educational programmes should be focused on altering attitudes identified by the study as being associated with under-reporting. Our data also indicate that community pharmacists must be a priority target for this intervention.

Do pharmacists' opinions affect their decision to dispense or recommend a visit to a doctor?

PURPOSE: To assess the relation between the pharmacists' opinions and the decision to dispense drugs without medical prescription and to recommend a visit to a doctor. METHODS: We carried out a cohort study on a sample of 166 pharmacists in North-West Spain. Pharmacists' opinions on prescription practice of the doctors, on pharmacists' qualification to dispense drugs without medical prescription, on their responsibility about dispensed drugs, on clients' qualification for self-medication, and pharmacists' perception of their work were collected through a personal interview. Dispensing and the recommendation to the patient to visit their doctor were measure in the follow-up. We constructed logistic regression models. RESULTS: The response rate to the first questionnaire was 98.8% and the participation rate in the follow-up was 60%. Pharmacists who considered that doctors prescribed excessively were less likely to dispense without medical prescription (OR = 0.48) and to send the client to the doctor more often (OR = 2.33). On the other hand, those who considered themselves to be capable to dispense without prescription do so frequently (OR = 1.24). A major appreciation of the pharmacist as a health educator was associated with a higher dispensing (OR = 3.81). Pharmacists who considered that customers' qualification for self-medication was good recommended, more frequently visiting a doctor (OR = 1.58). CONCLUSIONS: Our results show that the pharmacists' opinions are associated with their practice of counseling. Therefore, any program designed with the purpose of changing dispensing habits of the pharmacists should identify and take into account their opinions.

Alergia a animales de experimentación / Allergy to laboratory animals

En este trabajo de información se quiere insistir en el riesgo que supone para los trabajadores expuestos a animales de laboratorio no tomar las medidas adecuadas para evitarlos. Las alergias a animales de laboratorio, descritas hace varios años, suponen un motivo de aparición de diversos síntomas que pueden oscilar entre rinitis o conjuntivitis y la aparición de broncoespasmo. Por este motivo, todo trabajador que desempeñe sus funciones en este campo debe estar debidamente informado y, antes de entrar en dichas áreas de trabajo, debe realizarse un reconocimiento médico encaminado a buscar posibles factores de riesgo que precipiten las patologías comentadas. En el caso de que dichas patologías aparecieran con motivo de su trabajo, éstas deberían tomarse como patologías profesionales (AU)

Data collection methods for analyzing the quality of the dispensing in pharmacies.

OBJECTIVE: To review and discuss the advantages and limitations of the different data collection methods for analyzing the dispensing quality in community pharmacies. METHODS: A bibliographic search was carried out in MEDLINE (1980-2000). Articles with Medical Subject Heading (Mesh) "pharmacies" written in English and Spanish that evaluated the quality of dispensing (structure, process or outcome) were selected. RESULTS: Various data collection methods were observed. To analyze the quality of the structure, questionnaires and pharmacist interviews were used. To analyze the quality of the process, self-completed records, external observers and simulated clients were used. For analyzing the quality of the outcome, questionnaires, client interviews, and biologic samples were collected. CONCLUSIONS: The analysis of quality of structure can be useful as a first approach, however, this method may lack sensitivity. On the other hand, the analysis of outcome may be excessively complex and difficult to use, except for experimental or observational studies with large resources. Therefore, an analysis of the quality of the process is the best option. Methods utilizing external observers and simulated clients may best conjugate both internal and external validity.

Physicians' attitudes towards voluntary reporting of adverse drug events.

At the time a new drug is placed on the market, information on its therapeutic effect and toxicity is limited. Because of its simplicity and widespread use, the voluntary reporting by clinical physicians is the main method for detecting rare or unexpected adverse drug events (ADEs). However, the usefulness of this method may be compromised if the reporting rate is low. We present the results of a questionnaire-based case-control study carried out among 692 physicians from Galicia (north-west region of Spain), in which we assessed their attitudes and opinions towards ADEs. In general, the Galician physicians think it is difficult to link a given ADE with a drug (P < 0.05) and have very heterogeneous opinions on the fact that very severe ADEs are known before the drug is commercialized. They globally disagree with the proposal that ADE reporting should be renumerated and the fact that ADE reporting can be risky for the physician. Some of the beliefs concerning ADEs are incorrect. It is crucial to improve the training of the physicians through active educational strategies based on personal contact.

Variables explicativas del gasto evitable generado por la no prescripción de la especialidad equivalente de menor precio / Explanatory variables of avoidable cost produced by not prescribing a cheaper equivalent drug

Objetivo: Identificar las variables explicativas del gasto evitable por la no prescripción de la especialidad de menor precio. Métodos: Se diseñó un estudio transversal sobre la población de médicos generales de atención primaria de Galicia (n = 1.500). Se seleccionó una muestra de 405 sujetos. Se recogieron las siguientes variables independientes a través de cuestionario postal: especialidad del médico, percepción de la calidad de las distintas fuentes de información de medicamentos, integración en equipos de atención primaria y número de pacientes. Las características del entorno fueron obtenidas a través de fuentes secundarias. Se generaron dos modelos de regresión múltiple utilizando como variables dependientes dos indicadores basados en el gasto evitable generado por la no prescripción de la especialidad esencialmente similar de menor precio. Resultados: El porcentaje de respuesta fue del 77,4 por ciento. La eficiencia de la prescripción no se encontró asociada con el nivel de formación del médico ni con las variables de utilización y de calidad atribuida a la información comercial o institucional. Tampoco la variable modelo sanitario resulta significativa. Únicamente el número de cartillas y el porcentaje de cartillas de pensionista muestran significación estadística. Conclusiones: Los resultados del estudio sugieren la escasísima importancia que los médicos conceden a la eficiencia en la prescripción. Así, con el fin de disminuir el gasto evitable por la no prescripción de la especialidad esencialmente similar de menor precio se debería reorientar los planes de estudios en la línea de asegurar que sus contenidos reflejen las prioridades sanitarias nacionales y los recursos existentes (AU)

Effectiveness of educational interventions on the improvement of drug prescription in primary care: a critical literature review.

This paper is a critical review of studies of educational programmes designed to improve prescription practices in ambulatory care. Scientific articles were selected from the following bibliographical indices: MEDLINE, IME, ICYT and ERIC. The searches covered the time period between 1988 and 1997. The search criteria included: primary-care, educat*, prescription* and other related keywords. The inclusion criteria were studies describing educational strategies aimed at general practitioners working in ambulatory settings. The study outcome was change in prescribing behaviour of physicians through prescribing indicators. The following data were extracted: study design, target drugs, type of intervention, follow-up period of the prescription trends, type of data analysis, type of statistical analysis and reported results. We found 3233 articles that met the search criteria. Of these, 51 met the inclusion criteria and 43 studied the efficacy/effectiveness of one or various interventions as compared to no intervention. Among seven studies evaluating active strategies, four reported positive results (57%), as opposed to three of the eight studies assessing passive strategies (38%). Among the 28 studies that tested reinforced active strategies, 16 reported positive results for all variables (57%). Eight studies were classified as a high degree of evidence (16%). We concluded that the results of our review suggest that the more personalized, the more effective the strategies are. We observe that combining active and passive strategies results in a decrease of the failure rate. Finally, better studies are still needed to enhance the efficacy and efficiency of prescribing practices.

A cohort study of stress and the common cold.

The common cold is one of the major causes of work absenteeism. Former studies, based on artificial inoculation of rhinovirus, implicated psychological stress in the occurrence of this syndrome, either by increasing susceptibility to the virus or by causing the subject to overrate the perception of the symptoms. Nevertheless, few studies on the effect of stress on the naturally acquired common cold have been conducted. We carried out a 1-year prospective cohort study among the faculty and staff of a Spanish university (N = 1,149). By means of standardized questionnaires, validated in a random sample of the population, we assessed the relation between the occurrence of common cold episodes and exposure to four dimensions of stress: stressful life events, negative affect, positive affect, and perceived stress. All four aspects of stress were related to the occurrence of the common cold. Subjects with a high (fourth quartile) index of negative affect showed an incidence rate ratio of 3.7 (95% confidence interval = 2.2-6.2). The incidence rate ratios for the fourth quartile were 2.5 (95% confidence interval = 1.5-4.1) and 1.9 (95% confidence interval = 1.1-3.2) for perceived stress and stressful events, respectively. A high index of positive affect was associated with an incidence rate ratio of 0.6 (95% confidence interval = 0.3-1.0). These findings suggest that psychological stress is a risk factor for the common cold.

One-to-one versus group sessions to improve prescription in primary care: a pragmatic randomized controlled trial.

OBJECTIVES: The objective of the study was to evaluate the effectiveness of 2 educational strategies aimed at improving prescribing standards in primary care. METHODS: A pragmatic controlled trial was designed; the study population included general and family practitioners in Galicia (northwestern Spain) divided into 3 study groups: a one-to-one education group (n = 98), a by-group education group (n = 92), and a control group (n = 405). The educational intervention included explicit recommendations for selecting nonsteroidal anti-inflammatory drugs (NSAIDs) for inflammation signs. Some of the subjects were given reminders. Mixed-effect linear models were applied to data analysis. Analyses were done by intention-to-treat. The dependent variable is a rate with a numerator that is the number of prescribed units of the NSAIDs recommended during intervention; the denominator is the total number of prescribed units of the NSAID total. RESULTS: One-to-one education obtained an average prescribing behavior improvement of 6.5% (P < 0.001) in the 9 months after intervention. In the education group, the average improvement was 2.4% (P < 0.05) for the same period. Statistically significant differences were observed between the group intervention and one-to-one groups. The reminder increased significantly the effectiveness of the one-to-one intervention. CONCLUSIONS: A single, short educational session to primary care doctors can improve their prescribing standards during long periods of > or = 9 months. Of the 2 strategies followed in the trial, one-to-one education has shown to be the most effective. Results also show that the effectiveness of these interventions increases when presented together with written material.