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Acute heart failure - an EFIM guideline critical appraisal and adaptation for internists
No full textOver the past two decades, several studies have been conducted that have tried to answer questions on management of patients with acute heart failure (AHF) in terms of diagnosis and treatment. Updated international clinical practice guidelines (CPGs) have endorsed the findings of these studies. The aim of this document was to adapt recommendations of existing guidelines to help internists make decisions about specific and complex scenarios related to AHF. The adaptation procedure was to identify firstly unresolved clinical problems in patients with AHF in accordance with the PICO (Population, Intervention, Comparison and Outcomes) process, then conduct a critical assessment of existing CPGs and choose recommendations that are most applicable to these specific scenarios. Seven PICOs were identified and CPGs were assessed. There is no single test that can help clinicians in discriminating patients with acute dyspnoea, congestion or hypoxaemia. Performing of echocardiography and natriuretic peptide evaluation is recommended, and chest X-ray and lung ultrasound may be considered. Treatment strategies to manage arterial hypotension and low cardiac output include short-term continuous intravenous inotropic support, vasopressors, renal replacement therapy, and temporary mechanical circulatory support. The most updated recommendations on how to treat specific patients with AHF and certain comorbidities and for reducing post-discharge rehospitalization and mortality are provided. Overall, 51 recommendations were endorsed and the rationale for the selection is provided in the main text. Through the use of appropriate tailoring process methodology, this document provides a simple and updated guide for internists dealing with AHF patients.Ye
Efficacy of a Mobile Health App (eMOTIVA) Regarding Compliance With Cardiac Rehabilitation Guidelines in Patients With Coronary Artery Disease: Randomized Controlled Clinical Trial.
No full textCardiovascular disease remains the leading cause of death worldwide, accounting for 17.9 million fatalities each year. In Europe, approximately 4 million deaths annually are attributed to cardiovascular diseases. Despite significant advances in the diagnosis and treatment of acute coronary syndrome (ACS), nearly half of these deaths are caused by ischemic heart disease. In Spain, coronary heart disease—primarily acute myocardial infarction (AMI)—continues to be the top cause of mortality, responsible for 29,068 deaths per year. Therefore, reducing the prevalence of ACS is a key public health priority. Extensive evidence demonstrates that adopting a healthy lifestyle and managing cardiovascular risk factors (CVRFs)—including quitting smoking, following a healthy diet, losing weight, maintaining appropriate physical activity levels, and adhering to prescribed medications—are essential for preventing major adverse cardiac and cerebrovascular events and reducing mortality in individuals with coronary artery disease (CAD).A subsidy was received to finance Research and Biomedical Innovation in Health Sciences within the framework of the Integrated Territorial Initiative 2014-2020 for the province of Cádiz. The project was 80% co-financed by the European Union through the FEDER (European Regional Development Fund) Andalusia Operational Program 2014-2020, and supported by the Ministry of Health and Consumption, Junta de Andalucía (reference code: PI-0014-2019). JAT is funded by CIBEROBN (Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición; CB12/03/30038)–Instituto de Salud Carlos III, IUNICS (Instituto Universitario de Investigación en Ciencias de la Salud), IDISBA (Fundación Instituto de Investigación Sanitaria Islas Baleares), and is co-funded by the European Regional Development Fund.Ye
Plan de Investigación, Desarrollo e innovación del Centro de Emergencias Sanitarias 061. Servicio Andaluz de Salud.
No full textEl Centro de Emergencias Sanitarias 061 (CES061) reconoce la importancia de la investigación y la innovación para mejorar la calidad de la atención prehospitalaria, estableciendo directrices y objetivos para integrarlas en su operativa diaria. Estas actividades no solo permiten optimizar protocolos y tecnologías, sino también contribuir al avance del conocimiento en emergencias sanitarias, posicionando al centro como un referente en el sector. En este sentido, el CES061 reafirma su compromiso con la investigación y la innovación como pilares fundamentales para la mejora continua de los servicios prehospitalarios. El plan de I+D+i 2025-2030 establece una hoja de ruta centrada en la integración de nuevas tecnologías, la generación de conocimiento y la transferencia de resultados a la práctica asistencial, en alineación con los estándares europeos y nacionales en la materia. Con ello, el CES061 busca consolidarse como un referente nacional e internacional en la investigación e innovación en emergencias sanitarias y fortalecer su papel en la gestión eficiente de situaciones críticas. Este plan sigue los principios de gestión de la I+D+i de la Norma Española UNE 166002:2021, basada en la generación de conocimiento, la realización de valor, el liderazgo orientado al futuro, la dirección estratégica, la cultura innovadora, las ideas con propósito, la gestión de la incertidumbre, la adaptabilidad y el enfoque sistémico.Este documento redactado como el primer Plan de I+D+i del Centro de Emergencias Sanitarias 061 (CES061), no hubiese sido posible sin la visión de varias de las personas que trabajaron por la investigación e innovación desde la Empresa Pública de Emergencias Sanitarias (EPES). Gracias a Luis Olavarría Govantes, Manuel González Guzmán y Fernando Rosell Ortiz que junto a administración, Margarita Hidalgo Martín y numerosos profesionales asistenciales consiguieron ser pioneros y artífices de grandes proyectos autonómicos, nacionales e internacionales financiados,en una organización relativamente pequeña, aunque muy extensa. Este plan refleja en gran medida los valores de excelencia, innovación y compromiso con la salud pública que ellos han encarnado y que han sabido transmitir con generosidad. Su guía ha sido esencial para establecer las bases de investigación e innovación de un centro de emergencias sanitarias que aspira a estar a la vanguardia de la atención médica urgente, la investigación aplicada y la innovación tecnológica en beneficio de nuestros pacientes y de la sociedad en general.N
Vol. 29, nº 43. Enfermedad neumocócica invasora. Andalucía, año 2023
No full textEnfermedades de Declaración Obligatoria por provincias. Semana 22/2024 y acumulado desde la semana 01/2024. Datos provisionales. Incluye además el artículo titulado “Enfermedad neumocócica invasora. Andalucía, año 2023”, de “Virtudes Gallardo García, Nicola Lorusso”.N
SEOM-GEM clinical guidelines for cutaneous melanoma (2023)
No full textCutaneous melanoma incidence is rising. Early diagnosis and treatment administration are key for increasing the chances of survival. For patients with locoregional advanced melanoma that can be treated with complete resection, adjuvant-and more recently neoadjuvant-with targeted therapy-BRAF and MEK inhibitors-and immunotherapy-anti-PD-1-based therapies-offer opportunities to reduce the risk of relapse and distant metastases. For patients with advanced disease not amenable to radical treatment, these treatments offer an unprecedented increase in overall survival. A group of medical oncologists from the Spanish Society of Medical Oncology (SEOM) and Spanish Multidisciplinary Melanoma Group (GEM) has designed these guidelines, based on a thorough review of the best evidence available. The following guidelines try to cover all the aspects from the diagnosis-clinical, pathological, and molecular-staging, risk stratification, adjuvant therapy, advanced disease therapy, and survivor follow-up, including special situations, such as brain metastases, refractory disease, and treatment sequencing. We aim help clinicians in the decision-making process.Ye
Socioeconomic inequalities in adherence to clinical practice guidelines and breast cancer survival: a multicentre population-based study in Spain
No full textWomen residing in lower socioeconomic status (SES) areas have lower breast cancer survival but it is not clear how differences in the quality of care received contribute to these disparities. We compared adherence to clinical practice guidelines (CPG) for the diagnosis and treatment of breast cancer and subsequent breast cancer survival between women residing in lower versus higher SES areas. We conducted a multicentre population-based study of all new cases of invasive breast cancer in women diagnosed 2010-2014 in six Spanish provinces with population-based cancer registries (n=3206). Clinical data were extracted in the framework of the European Cancer High Resolution studies and vital status follow-up covered a minimum of 5 years. SES of the patient's residence was measured with the 2011 Spanish Deprivation Index. Adherence to CPG was measured with 16 indicators based on European and Spanish guidelines. Relative survival was modelled using flexible parametric models. There were no differences in the type of treatment received but women living in the lowest SES areas were less likely to undergo a sentinel lymph node biopsy, reconstruction after mastectomy, surgery within 30 days after pathological diagnosis and adjuvant treatment within 6 weeks after surgery. After accounting for demographic and clinical factors, women residing in lower SES areas had higher risk of death, HR=1.57 (95% CI 1.04, 2.36). Further accounting for adherence to CPG in the model, in particular having undergone a sentinel lymph node biopsy, eliminated the significant effect of SES. Despite the overall coverage of the Spanish health system, women living in more deprived areas were less likely to receive care in line with CPG and had shorter survival.Ye
SEOM clinical guidelines for cancer anorexia-cachexia syndrome (2023)
No full textCancer-related anorexia-cachexia syndrome (CACS) is a debilitating condition afflicting up to 80% of advanced-stage cancer patients. Characterized by progressive weight loss, muscle wasting, and metabolic abnormalities, CACS significantly compromises patients' quality of life and treatment outcomes. This comprehensive review navigates through its intricate physiopathology, elucidating its stages and diagnostic methodologies. CACS manifests in three distinct stages: pre-cachexia, established cachexia, and refractory cachexia. Early detection is pivotal for effective intervention and is facilitated by screening tools, complemented by nutritional assessments and professional evaluations. The diagnostic process unravels the complex interplay of metabolic dysregulation and tumor-induced factors contributing to CACS. Management strategies, tailored to individual patient profiles, encompass a spectrum of nutritional interventions. These include dietary counseling, oral nutritional supplements, and, when necessary, enteral nutrition and a judicious use of parenteral nutrition. Specific recommendations for caloric intake, protein requirements, and essential nutrients address the unique challenges posed by CACS. While pharmacological agents like megestrol acetate may be considered, their use requires careful evaluation of potential risks. At its core, this review underscores the imperative for a holistic and personalized approach to managing CACS, integrating nutritional interventions and pharmacological strategies based on a nuanced understanding of patient's condition.Ye
A clinical practice guideline for the management of the foot and ankle in rheumatoid arthritis
No full textRheumatoid arthritis causes progressive joint destruction in the long term, causing a deterioration of the foot and ankle. A clinical practice guideline has been created with the main objective of providing recommendations in the field of podiatry for the conservative management of rheumatoid arthritis. Thus, healthcare professionals involved in foot care of adults with rheumatoid arthritis will be able to follow practical recommendations. A clinical practice guideline was created including a group of experts (podiatrists, rheumatologists, nurses, an orthopaedic surgeon, a physiotherapist, an occupational therapist and patient with rheumatoid arthritis). Methodological experts using GRADE were tasked with systematically reviewing the available scientific evidence and developing the information which serves as a basis for the expert group to make recommendations. Key findings include the efficacy of chiropody in alleviating hyperkeratotic lesions and improving short-term pain and functionality. Notably, custom and standardized foot orthoses demonstrated significant benefits in reducing foot pain, enhancing physical function, and improving life quality. Therapeutic footwear was identified as crucial for pain reduction and mobility improvement, emphasizing the necessity for custom-made options tailored to individual patient needs. Surgical interventions were recommended for cases which were non-responsive to conservative treatments, aimed at preserving foot functionality and reducing pain. Moreover, self-care strategies and education were underscored as essential components for promoting patient independence and health maintenance. A series of recommendations have been created which will help professionals and patients to manage podiatric pathologies derived from rheumatoid arthritis.Ye
The challenge of a hospital network digital library towards open science in a health public system. The institutional health repository of Andalusia (RISalud-ANDALUCIA)
No full textThe Andalusian Health Digital Library (BV-SSPA) was set in 2006. The main milestone was the centralized subscription for 65 hospitals, 5 research centers, 3 training centers and 1,500 primary centers. The Health Public System of Andalusia is composed of more than 100,000 professional who can access the digital library at work and remotely since 2008, when the federeted access system was developped. In 2013 the BV-SSPA launched the Institutional Health Repository (RISalud-ANDALUCIA) where all the scientific and intellectual output of these proffesionals could be deposited. In 2022 this digital library assumed the challenge of evolving the repository which also implied certain changes in centralized licensing and agreement with publishers.
In this presentation, the Implementation of improvements in RISalud-ANDALUCIA which implies changes in its software, bulk uploads, new structure, but also a new approach in terms of subscription negotiations, is shown.Ye
Real-World Safety and Efficacy Profile of Baricitinib in Patients With Atopic Dermatitis: a Multicenter Retrospective Trial From Four Spanish Hospitals in Andalusia
No full textEl documento tiene un embargo hasta el 31 de enero de 2025.Tras la publicación de los resultados de los ensayos clínicos con baricitinib BREEZE, el baricitinib fue aprobado para el tratamiento de la dermatitis atópica (DA) moderada-grave. Describimos una serie de 13 pacientes diagnosticados de DA moderada-grave y tratados con baricitinib 4 mg/día con un periodo de seguimiento de 16 semanas. El estudio fue aprobado por el Comité de Ética hospitalario (DER-HUSC- 2022-009)Ye