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Procalcitonin in the Emergency Department: A potential expensive over-request that can be modulated through institutional protocols.

  • Salinas M
  • López-Garrigós M
  • Flores E
  • Uris J
  • Leiva-Salinas C
  • Pilot Group of the Appropriate Utilization of Laboratory Tests (REDCONLAB) worki
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Clinical and epidemiological characteristics of pyogenic liver abscess in people 65 years or older versus people under 65: a retrospective study

  • Peris J
  • Bellot P
  • Roig P
  • Reus S
  • Carrascosa S
  • González-Alcaide G
  • Palazon J
  • Ramos J
Background: To analyse the clinical, epidemiological, microbiological and prognostic differences of pyogenic liver abscess (PLA) in older (>= 65 years of age) versus younger patients (<65 years). Methods: Multicentre, retrospective cohort study in all patients with PLA admitted to two Spanish hospitals from January 2000 to January 2014. Cases were divided into two age groups (<65 years and >= 65 years) for comparison of clinical, epidemiological and microbiological characteristics as well as treatment. Results: Of 98 patients analysed, 40 patients were younger than 65, and 58 were aged 65 or older. Significant associations in the older group were found with female sex (adjusted odds ratio [ORa] 9.0; 95% CI 1.4, 56), non-cryptogenic origin (ORa 14.5; 95% CI 1.6, 129), absence of chronic liver disease (ORa 14; 95% CI 1.3, 155), Escherichia coli infection (ORa 7.7; 95% CI 1.03, 58), and incidence of complications (ORa 2.3; 95% CI 1.04, 5.4). Mortality was 8.2% overall, although all deaths occurred in the older group (8/58; 13.8%) (p = 0.02). Discussion: Our results are in consonance with other published studies. Older patients with PLA tend to present more anomalies in the biliary tract (Kai et. al, World J Gastroenterol 18: 2948-295, 2012, Rahimian et. al, Clin Infect Dis 39: 1654-9, 2004, Seeto, Medicine (Baltimore) 75: 99-113, 1996, Kao et. al, Aliment Pharmacol Ther 36: 467-76, 2012, Lai et. al, Gastroenterology 146: 129-37, 2014), while younger patients are more often male and present more commonly with previous liver disease (especially related to alcohol) and cryptogenic PLA. Conclusion: In patients aged 65 or older, PLA was more common in women and in those with a history of biliary disease, and E. coli was the most frequent bacterium. Mortality was also higher in the older group.
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Influence of renal function on anticoagulation control in patients with non-valvular atrial fibrillation taking vitamin K antagonists

  • Lobos-Bejarano JM
  • Castellanos Rodríguez A
  • Barrios V
  • Escobar C
  • Polo-García J
  • Del Castillo-Rodríguez JC
  • Vargas-Ortega D
  • Lopez-Pineda A
  • Prieto-Valiente L
  • Lip GYH
  • PAULA Study Team
Background and PurposeChronic kidney disease (CKD) has been related to poor anticoagulation control and an increased risk of bleeding. This study aims to evaluate the association between impaired renal function (eGFR <60mL/min/1.73m(2)) and anticoagulation control in patients with non-valvular atrial fibrillation (AF) on vitamin K antagonists (VKA) therapy. We also assessed whether the predictive value of the SAMe-TT2R2 score prevailed for subgroups both with and without CKD. MethodsThis is an ancillary analysis of 1381 patients from the PAULA study, which was a cross-sectional, retrospective and nationwide multicenter study. ResultsA total of 370 patients had eGFR <60mL/min/1.73m(2). Anticoagulation control levels progressively worsened across each stage of CKD. Multiple linear regression analysis showed CKD as an independent predictor of time in therapeutic range (TTR). In the subgroup of patients with preserved renal function, female sex, diet affecting INR, polypharmacy and amiodarone were associated with poorer TTR. The SAMe-TT2R2 score had a significant but modest predictive value for TTR<65% (AUC, area under the curve 0.558, P=.002). In the subgroup of patients with CKD, the SAMe-TT2R2 (>2 points) showed no significant predictive capacity for TTR (AUC 0.528, P=.354). The average TTR was similar for both sexes (P=.255), but with a higher percentage of males subjects with TTR 65% (P=.013). ConclusionChronic kidney disease is associated with poor anticoagulation control in patients with non-valvular AF taking VKA. The SAMe-TT2R2 score was not predictive of poor TTR in the subgroup with CKD, although a modest predictive value for poor TTR was found in those without CKD.
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Burnout syndrome in nurses working in palliative care units: An analysis of associated factors

  • Rizo-Baeza M
  • Mendiola-Infante SV
  • Sepehri A
  • Palazon A
  • Gil V
  • Cortés-Castell E
AimsTo analyse the association between psychological, labour and demographic factors and burnout in palliative care nursing. BackgroundThere is a lack of published research evaluating burnout in palliative care nursing. MethodsThis observational cross-sectional study involved 185 palliative care nurses in Mexico. The primary variables were burnout defined by its three dimensions (emotional exhaustion, depersonalization and personal accomplishment). As secondary variables, psychological, labour and demographic factors were considered. A binary logistic regression model was constructed to determine factors associated with burnout. ResultsA total of 69 nurses experienced high emotional exhaustion (37.3%), 65 had high depersonalization (35.1%) and 70 had low personal performance (37.8%). A higher proportion of burnout was found in the participants who were single parents, working >8hr per day, with a medium/high workload, a lack of a high professional quality of life and a self-care deficit. ConclusionOur multivariate models were very accurate in explaining burnout in palliative care nurses. These models must be externally validated to predict burnout and prevent future complications of the syndrome accurately. Implications for Nursing ManagementNurses who present the factors found should be the focus of interventions to reduce work stress.
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Construction, internal validation and implementation in a mobile application of a scoring system to predict nonadherence to proton pump inhibitors

  • Mares-García E
  • Palazon A
  • Folgado-de la Rosa DM
  • Pereira-Expósito A
  • Martínez-Martín Á
  • Cortés-Castell E
  • Gil V
Background. Other studies have assessed nonadherence to proton pump inhibitors (PPIs), but none has developed a screening test for its detection. Objectives. To construct and internally validate a predictive model for nonadherence to PPIs. Methods. This prospective observational study with a one-month follow-up was carried out in 2013 in Spain, and included 302 patients with a prescription for PPIs. The primary variable was nonadherence to PPIs (pill count). Secondary variables were gender, age, antidepressants, type of PPI, non-guideline-recommended prescription (NGRP) of PPIs, and total number of drugs. With the secondary variables, a binary logistic regression model to predict nonadherence was constructed and adapted to a points system. The ROC curve, with its area (AUC), was calculated and the optimal cut-off point was established. The points system was internally validated through 1,000 bootstrap samples and implemented in a mobile application (Android). Results. The points system had three prognostic variables: total number of drugs, NGRP of PPIs, and antidepressants. The AUC was 0.87 (95% CI [0.83-0.91], p < 0.001). The test yielded a sensitivity of 0.80 (95% CI [0.70-0.87]) and a specificity of 0.82 (95% CI [0.76-0.87]). The three parameters were very similar in the bootstrap validation. Conclusions. A points system to predict nonadherence to PPIs has been constructed, internally validated and implemented in a mobile application. Provided similar results are obtained in external validation studies, we will have a screening tool to detect nonadherence to PPIs.
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Urinary albumin: a risk marker under-requested in primary care in Spain

  • Salinas M
  • López-Garrigós M
  • Flores E
  • Leiva-Salinas C
  • Pilot Group of the Appropriate Utilization of Laboratory Tests
Background To study the inter-practice regional variation in the request of urinary albumin by general practitioners and compare to guideline recommendations. Methods A cross-sectional study enrolled laboratories from different Spanish autonomous communities. Laboratories were invited to report the number of urinary albumin requested by general practitioners during 2012 and 2014. Urinary albumin requested per 1000 inhabitants and the index of variability (90th centile/10th centile) was calculated, and compared between autonomous communities and time periods. To investigate potential inappropriate requesting in the management of diabetes and arterial hypertension, the actual number of requests was compared to the theoretical, based on prevalence and guideline recommendations. Results Urinary albumin requested per 1000 inhabitants was similar for years 2012 and 2014 (78.2 (60.1) to 85.4 (55.4); P=0.235), as was the variability index (4.6 for both). There were significant differences between autonomous communities, with the indicator ranging from 46.0 (33.1) to 125.8 (64.3) (P<0.05). The theoretical cut-off ratios of urinary albumin per 1000 inhabitants to manage patients with diabetes and arterial hypertension were, respectively, 78 and 159; no laboratory reached both values. Conclusions Requesting of urinary albumin showed a significant regional variability in primary care in Spain, and was insufficient to correctly monitor patients with diabetes and arterial hypertension.
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Clinical benefit of the FIFA 11 programme for the prevention of hamstring and lateral ankle ligament injuries among amateur soccer players

  • Nouni-Garcia R
  • Carratala-Munuera C
  • Orozco D
  • Lopez-Pineda A
  • Asensio-Garcia MR
  • Gil V
Objective To analyse the relationship between the implementation of the 11' protocol during the regular season in a men's amateur soccer team and the rate of hamstring and lateral ankle ligament (LAL) injuries, and to estimate the clinical benefit of the programme according to the type of injury and the position field. Methods This cohort study was conducted in two different men's amateur soccer teams. During two seasons, the exposed group (43 players) performed the 11' protocol twice a week, and the unexposed group (43 players) performed the regular training programme. All players trained three times per week for 1.5hours per day. Data collection was performed for every 1000hours of play. Results 18 hamstring injuries (injury rate (IR) of 2.26 injuries/1000 training+competition hours) and 15 LAL injuries (IR of 1.88 injuries/1000) were registered in the exposed group. In the unexposed group, there were 25 LAL injuries (IR of 3.14 injuries/1000) and 35 hamstring injuries (IR of 4.39 injuries/1000). The number needed to treat to prevent one new case was 3.9 in LAL injuries, 3.31 in biceps femoris injuries and 10.7 in recurrent hamstring injuries. Conclusions The 11' programme reduced the incidence of hamstring and LAL injuries in amateur players. According to the field position, the programme was effective for defenders and midfielders. In accordance with the type of injury, the exposed group had a lower risk of LAL, biceps femoris and hamstring injuries compared with those in the unexposed group.
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