Effects of the COVID-19 Pandemic on Prehospital Emergency Care for Adults with Stroke and Transient Ischaemic Attack: A Systematic Review and Meta-Analysis.

INTRODUCTION: COVID-19 has challenged global health care systems and resulted in prehospital delays for time-sensitive emergencies, like stroke and transient ischemic attacks (TIA). However, there are conflicting international reports on the level of effect of the pandemic on ambulance response intervals and emergency call volumes for these conditions. OBJECTIVES: The purpose of this study was to synthesize the international evidence on the effect of COVID-19 on ambulance response intervals and emergency call volume for suspected stroke and TIA. METHODS: Following a published protocol, we conducted a systematic search of six databases through May 31, 2022. We re-ran this search on April 14, 2023, to check for any new papers. We considered for inclusion peer-reviewed quantitative studies comparing prehospital emergency care for adults with suspected stroke/TIA before and during the COVID-19 pandemic. Two authors screened title/abstract and full text articles. One author carried out data extraction, with a random selection of articles being checked by another author. We calculated overall pooled estimates of ambulance intervals (activation, response, patient care, and total prehospital intervals) and stroke/TIA emergency call volume. Subgroup and sensitivity analyses included location and stroke/TIA diagnosis. Two authors assessed study quality using the appropriate Joanna Briggs Institute tool. We worked with patient and public involvement contributors and clinical and policy stakeholders throughout the review. RESULTS: Of 4,083 studies identified, 52 unique articles met the inclusion criteria. Mean response interval (-1.29 min [-2.19 to -0.38]) and mean total prehospital interval (-6.42 min [-10.60 to -2.25]) were shorter in the pre-COVID-19 period, compared to the COVID-19 period. Furthermore, there was a higher incidence rate of emergency call volume for suspected stroke/TIA per day pre-COVID-19 compared with the COVID-19 period (log IRR = 0.17 [0.02 to 0.33]). Ambulance response interval definitions and terminology varied between regions and countries. CONCLUSIONS: Our review indicates that prehospital delays for suspected stroke/TIA increased during the COVID-19 pandemic. Furthermore, emergency call volume for suspected stroke/TIA decreased during this period. In order to minimize delays in future pandemics or other health care emergencies future research may involve understanding the potential reasons for these delays.

Effects of the COVID-19 pandemic on prehospital emergency care for adults with stroke and transient ischaemic attack: A protocol for a systematic review and meta-analysis.

Background: The COVID-19 pandemic impacted on health service provision worldwide, including care for acute time sensitive conditions. Stroke and transient ischaemic attacks (TIA) are particularly vulnerable to pressures on healthcare delivery as they require immediate diagnosis and treatment. The global impact of the COVID-19 pandemic on prehospital emergency care for stroke/TIA is still largely unknown. Thus, the aim of this study is to conduct a systematic review and meta-analysis to investigate the impact of the COVID-19 pandemic on prehospital emergency care for stroke and TIA. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, the review is registered on PROSPERO (registration number CRD42022315260). Peer-reviewed quantitative studies comparing prehospital emergency care for adults with stroke/TIA before and during the COVID-19 pandemic will be considered for inclusion. The outcomes of interest are ambulance times and emergency call volumes for stroke/TIA. A systematic search of databases including PubMed, Embase and Scopus will be conducted. Two authors will independently screen studies for inclusion based on predetermined inclusion and exclusion criteria. Data extraction and quality assessment will be conducted by two authors. Meta-analysis will be performed to calculate overall pooled estimates of ambulance times (primary outcome) and stroke/TIA call volumes (secondary outcome), where appropriate.  Where heterogeneity is low a fixed-effects model will be used and where heterogeneity is high a random-effects model will be used. Subgroup and sensitivity analyses will include location, stroke/TIA diagnosis and COVID-19 case numbers. Results: Data on primary and secondary outcomes will be provided. Results of subgroup/sensitivity analyses and quality assessment will also be presented. Conclusions: This review will identify existing evidence reporting the impact of the COVID-19 pandemic on prehospital emergency care for adult patients with stroke/TIA and provide summary estimates of effects on ambulance response times.

Self-management support preferences of people with asthma or chronic obstructive pulmonary disease: A systematic review and meta-synthesis of qualitative studies.

OBJECTIVES: To synthesise findings from qualitative studies on the preferences of people with asthma or chronic obstructive pulmonary disease (COPD) for self-management support. METHODS: A thematic synthesis of literature was carried out. Six databases (ASSIA, CINAHL, MEDLINE, PsycINFO, Psychology and the Behavioural Sciences and SSCI) were used to search for qualitative studies eliciting perspectives of adults with asthma and/or COPD on self-management support, published between May 2008 and April 2018. RESULTS: A total of 968 articles were retrieved across databases, with 15 articles included in the synthesis. Three themes were identified: Types of Support described the range of supports valued by participants in the studies, particularly education provided by competent healthcare professionals; The Support Relationship highlighted the importance of a collaborative relationship with one's healthcare professional which was characterised by communication, trust and continuity over time and Accessibility identified the considerations of participants relating to physically accessible, prompt support which is provided in a format preferred by the individual. DISCUSSION: Increased understanding of patients' preferences may provide insight which can be used to enhance engagement with self-management support. Further research needs to examine self-management support preferences outside the context of evaluating interventions for people with asthma/COPD and needs to address the optimal means of enhancing accessibility.

Inyección de fibrina epidural como tratamiento conservador de la fuga persistente de líquido cefalorraquídeo tras cateterización intratecal / No disponible

No disponible

Vitamin C transporters

Vitamin C is a wide spectrum antioxidant essential for humans, which are unableto synthesize the vitamin and must obtain it from dietary sources. There are two biologicallyimportant forms of vitamin C, the reduced form, ascorbic acid, and the oxidizedform, dehydroascorbic acid. Vitamin C exerts most of its biological functionsintracellularly and is acquired by cells with the participation of specific membranetransporters. This is a central issue because even in those species capable of synthesizingvitamin C, synthesis is restricted to the liver (and pancreas) from which is distributedto the organism. Most cells express two different transporter systems for vitaminC; a transporter system with absolute specificity for ascorbic acid and a secondsystem that shows absolute specificity for dehydroascorbic acid. The dehydroascorbicacid transporters are members of the GLUT family of facilitative glucose transporters,of which at least three isoforms, GLUT1, GLUT3 and GLUT4, are dehydroascorbicacid transporters. Ascorbic acid is transported by the SVCT family ofsodium-coupled transporters, with two isoforms molecularly cloned, the transportersSVCT1 y SVCT2, that show different functional properties and differentialcell and tissue expression. In humans, the maintenance of a low daily requirement ofvitamin C is attained through an efficient system for the recycling of the vitamininvolving the two families of vitamin C transporters (AU)

No disponible

Parada cardiorrespiratoria en paciente sometido a colangiopancreatografía retrógrada endoscópica (CPRE) / No disponible

No disponible

Ziconotide: una alternativa innovadora en el dolor crónico neuropático intenso / Ziconide: An innovative alternative for intense chronic neuropathic pain

El dolor crónico intenso es un problema de salud de primer orden, ya que presenta un prevalenciaelevada (5-10%), una etiología multifactorial y un abordaje en muchas ocasiones realmente complejo. El tratamiento en los casos graves precisa, en ocasiones, abordajes intervencionistas, como los opioides vía intratecal en infusión continua. Casoclínico. Mujer de 38 años de edad, con dolor neuropático intenso en la zona lumbar y los miembros inferiores secundario a tres intervenciones en el segmento lumbar L5-S1. Tras diversos esquemas farmacológicos orales y mediante sistemas implantados(estimulador de cordones posteriores y bomba de infusión subaracnoidea con diferentes combinaciones farmacológicas) sin obtener mejoría clínica, se incluyó en el protocolo de infusión intratecal con ziconotide. Conclusiones. El ziconotide es el primer bloqueador neuronal específico que actúa sobre el canal de calcio, bloqueando los canales tipo N del calcio dependientesde voltaje. Es un nuevo analgésico no opioide con indicación aprobada en el tratamiento del dolor crónico intenso, en aquellos pacientes que requieren de analgesia intratecal, refractario a otros tratamientos analgésicos. Por lo tanto, deberemosconsiderar este fármaco como una alternativa de terapia en aquellos pacientes que con la farmacopea y los mediosdisponibles actualmente no encuentran alivio suficiente

Intense chronic pain is a very important health problem, as it has a high prevalence (5-10%), amultifactorial aetiology and its management is very often a very complex affair. Treatment of severe cases sometimes requires interventional approaches, such as continuous intrathecal infusion of opioids. Case report.We report the case of a 38-year-oldfemale with intense neuropathic pain in the lower back and the lower limbs secondary to three operations on the L5-S1 lumbar segment. After implementing several different pharmacological regimes involving both oral and implanted systems (spinal cord stimulation and subarachnoid infusion pump with different pharmacological combinations) with no clinicalimprovement, intrathecal infusion with ziconotide was included in the protocol. Conclusions. Ziconotide is the first specific neuronal blocker that acts on the calcium channel by blocking the N-type voltage-dependent calcium channels. It is a new nonopioidanalgesic with approved indication in the treatment of intense chronic pain, in patients who require intrathecalanalgesics and are refractory to other analgesic treatments. Therefore, we shall have to consider this drug as a therapeutic alternative in patients do not experience sufficient relief with the pharmacological agents and means currently available to treat them

Efectividad de una consulta de atención farmacéutica para el control del dolor crónico severo / Effectiveness of a pharmaceutical care unit for the control of severe chronic pain

Introducción: Se analiza la efectividad de la consulta de atención farmacéutica en un programa para el control del dolor crónico severo no maligno de enfermos geriátricos, dividido en fases y realizado en la unidad multidisciplinar de tratamiento del dolor del Consorcio Hospital General Universitario de Valencia. Material y métodos: Ciento cincuenta pacientes con indicación clínica de opioi de mayor, fueron incluidos en el tercer escalón de la analgesia de la OMS, por el equipo médico y tras una rigurosa selección. La consulta de atención farmacéutica o fase II, realizó un seguimiento de la escalada de dosis, hasta conseguir la estabilización del dolor con ausencia de efectos secundarios, así como el control en la instauración del tratamiento crónico posterior. Resultados: Al finalizar el programa, el 75% de los pacientes controlaron su dolor, precisando una media de 22,7 días para ajustar la dosis del opiáceo. La dosis media diaria fue de 22,3 mg y el estreñimiento tratado preventivamente desde el inicio. El 59% de los pacientes recibió tratamiento crónico posterior con parches de fentanilo transdérmico de 25 µg/h, un 10% continuó con solución oral de morfina y un 6% morfina de liberación controlada. El 25% de los pacientes restantes presentó incidencias relevantes, detectadas en la fase de escalada terapéutica, que motivaron la suspensión del tratamiento y el alta en la unidad por ineficacia terapéutica. A los 24 meses, el 70% de los pacientes continuaban con la dosis inicial. Conclusiones: La efectividad de la consulta queda reflejada al conseguir los objetivos del programa

Introduction: The effectiveness of a pharmaceutical care unit was assessed within a staged program for non-malignant severe chronic pain control in a multidisciplinary pain management unitat Consorcio Hospital General Universitario, Valencia, Spain. Materials and methods: One hundred and fifty patients with clinical indication for a major opioid were included in WHO’s third analgesic rung by our medical team following careful triage. The pharmaceutical care unit, or phase II, monitored dosage titration for pain stabilization with absence of side effects, as well as the onset of subsequent chronic therapy. Results: Upon program completion 75% of patients had their pain under control, having required 22.7 days on average for opiate dose titration. Mean daily dose was 22.3 mg, and constipation was prophylactically managed from the start. Fifty-nine percent of patients received subsequent chronic therapy with fentanyl transdermal patches at 25 ug/h; 10% followed suit with oral morphine solution, and 6% with controlled-release morphine. Twenty-five percent of the remaining patients had relevant events during the therapy titration stage, which led to therapy discontinuation and discharge because of lack of therapeutic effectiveness. After 24 months 70% of patients were still on initial doses. Conclusions: The effectiveness of our unit was demonstrated by the achievement of the program objectives