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Programació per motius : transformem la gestió de la demanda a l’atenció primària i comunitària
Get PDFProgramació per motius; Gestió de la demanda; Atenció primària i comunitàriaProgramación por motivos; Gestión de la demanda; Atención primaria y comunitariaReason-based programming; Demand management; Primary and community careAquest document descriu el procés complet del projecte de Programació per Motius (PxM), des de la seva concepció metodològica fins al seu desplegament i consolidació a tota l’atenció primària i comunitària de Catalunya. Amb un enfocament basat en l’evidència i la participació de molts professionals de tota Catalunya, el projecte ha integrat tecnologia i millora de processos per facilitar una assignació eficient de cites segons motius de consulta estandarditzats. El document recull la metodologia emprada, les fases del seu desenvolupament, el procediment d’ús de l’eina, els resultats obtinguts i les lliçons apreses durant el desplegament progressiu. Finalment, s’hi exposen les perspectives de futur, orientades a la sostenibilitat i evolució del model.
El virus de la gripe aviar H5N1 y la seguridad alimentaria
Get PDFGrip aviar; Seguretat alimentària; Animals de granjaGripe aviar; Seguridad alimentaria; Animales de granjaAvian influenza; Food safety; Farm animalsEl document descriu la situació actual del virus H5N1 a Espanya i Catalunya, amb augment de focus en aus i risc elevat per migracions. Analitza la transmissió a animals de granja, especialment via llet en bovins, i la presència en aliments (carn, ous, llet). Inclou mesures de control (cocció, pasteurització, higiene) i normativa europea. Conclou que el risc alimentari és molt baix si es mantenen bones pràctiques.El documento describe la situación actual del virus H5N1 en España y Cataluña, con aumento de focos en aves y riesgo elevado por migraciones. Analiza la transmisión a animales de granja, especialmente a través de la leche en bovinos, y la presencia en alimentos (carne, huevos, leche). Incluye medidas de control (cocción, pasteurización, higiene) y normativa europea. Concluye que el riesgo alimentario es muy bajo si se mantienen buenas prácticas.The document outlines the current situation of the H5N1 virus in Spain and Catalonia, noting an increase in outbreaks among birds and a high risk due to migrations. It examines transmission to farm animals, particularly via milk in cattle, and the presence in food (meat, eggs, milk). It includes control measures (cooking, pasteurization, hygiene) and European regulations. It concludes that the foodborne risk is very low if good practices are maintained
Does Empirical Antibiotic Use Improve Outcomes in Ventilated Patients with Pandemic Viral Infection? A Multicentre Retrospective Study
Get PDFEmpirical antibiotic treatment; Pandemic viral pneumonia; Ventilator-associated pneumoniaTratamiento antibiótico empírico; Neumonía viral pandémica; Neumonía asociada a ventilación mecánicaTractament antibiòtic empíric; Pneumònia vírica pandèmica; Pneumònia associada a ventilació mecánicaBackground: During the influenza A(H1N1) and COVID-19 pandemics, empirical antibiotic treatment (EAT) was widely administered to critically ill patients despite low rates of confirmed bacterial co-infection (COI). The clinical benefit of this practice remains uncertain and may contradict antimicrobial stewardship principles. Objective: To evaluate whether EAT at ICU admission reduces ventilator-associated pneumonia (VAP) incidence or ICU mortality in critically ill patients with pandemic viral pneumonia, stratified by presence of COI. Methods: This retrospective analysis combined two national multicentre ICU registries in Spain, including 4197 adult patients requiring invasive mechanical ventilation for influenza A(H1N1) or COVID-19 between 2009 and 2021. Primary outcomes were ICU mortality and VAP incidence. Analyses were stratified by microbiologically confirmed bacterial COI. Propensity score matching, Cox regression, General Linear (GLM), and random forest models were applied. Results: Among patients without COI (n = 3543), EAT was not associated with lower ICU mortality (OR = 1.02, 95%CI 0.81–1.28, p = 0.87) or VAP (OR = 1.02, 95%CI 0.79–1.39, p = 0.89). In patients with confirmed COI (n = 654), appropriate EAT was associated with reduced VAP (17.4% vs. 36.3%, p < 0.001) and ICU mortality (38.4% vs. 49.6%, OR = 1.89, 95%CI 1.13–3.14, p = 0.03) compared to inappropriate EAT. Conclusions: EAT was not associated with a lower incidence of VAP or higher survival rates and could be harmful if administered incorrectly. These findings support a more targeted approach to antibiotic use, guided by microbiology, biomarkers and stewardship principles.Barri Casanovas Private Foundation Scholarship (FBC02/2024) (AR; MB)
Marcadors i fàrmacs vinculats al Programa d'oncologia de precisió
Get PDFMarcadors; Fàrmacs; Programa d'oncologia de precisióMarcadores; Fármacos; Programa de oncología de precisiónMarkers; Medicines; Precision oncology programLa determinació molecular en determinats contextos clínics permet la selecció de pacients amb característiques moleculars que en estudis clínics s'han associat a una millor resposta a tractaments dirigits específics, en comparació amb pacients sense aquestes característiques. Aquesta aproximació permet una major probabilitat d'èxit, millorant les taxes de resposta i minimitzant l'ús de medicaments d'elevada toxicitat en situacions de resposta clínica improbable
Hypoplastic Left Heart Syndrome Practice Variation Across 31 Centres From 20 European Countries. An AEPC Imaging Working Group Study
Get PDFCongenital heart disease; Hypoplastic left heart syndrome; ImagingCardiopatía congénita; Síndrome del corazón izquierdo hipoplásico; ImágenesCardiopatia congènita; Síndrome del cor esquerre hipoplàstic; ImatgesDespite significant advances in knowledge and the development of guidelines, the management of hypoplastic left heart syndrome (HLHS) remains highly variable. A structured questionnaire was circulated across European Association of Paediatric & Congenital Cardiology (AEPC) affiliated centres. The aims were to evaluate standards in pre-operative assessment, types of surgery, follow-up and medical practices in children with HLHS. Thirty-one centres from 20 countries completed the survey. Delivery of babies with HLHS occurred in co-located maternity hospitals in 74% of centres; 29% were planned for spontaneous onset of labour, while 54% decided on a case-by-case basis. The preferred initial palliation was a right ventricle-pulmonary artery conduit in 55% of cases, modified Blalock-Thomas Taussig shunt (mBTTS) in 35%, and hybrid in 15% of cases. Timing for Glenn varied from 3 to 6 months of age and preoperative examination varied greatly: 65% performed cardiac catheterization and only 19% performed cardiac magnetic resonance. Stage III palliation was performed at a highly variable interval (2—6 years of age), nearly always employing an extracardiac conduit. Fenestration was routinely performed in 61% and reserved for borderline cases in 39%. All the centers adopted warfarin for the first 3–12 months after Fontan completion, and continued if a fenestration was present, while in non-fenestrated aspirin was left by most centers (e.g. 68%). However, there was a high disparity in the use of heart failure medications (e.g. in interstage I-II 35% use ACE-inhibitors, and only 26% digoxin). Follow-up practice also varied widely with only 60% employing specific protocols. Conclusion: This first multi-centre European survey from 31 centres from 20 different European countries highlighted a high practice variation in HLHS management across all the stages of Single Ventricle (Fontan) palliation. Major variations pertained to pre- and post-surgical investigations, surgical strategy for stage I and III, medical treatment regimens, and follow-up programs.Open Access funding provided by the IReL Consortium
Esophageal and Oropharyngeal Dysphagia: Clinical Recommendations From the United European Gastroenterology and European Society for Neurogastroenterology and Motility
Get PDFDelphi consensus; Esophageal motility disorders; High resolution manometryConsenso Delphi; Trastornos de la motilidad esofágica; Manometría de alta resoluciónConsens Delphi; Trastorns de la motilitat esofàgica; Manometria d'alta resolucióDysphagia is a prevalent symptom of the upper gastrointestinal tract causing health related consequences, impacting quality of life and is associated with global economic burden. Swallowing difficulties are classified into oropharyngeal dysphagia (OD) and esophageal dysphagia. Despite its clinical importance, dysphagia is associated with several uncertainties regarding its optimal diagnostic work-up and management, particularly, considering the progress with diagnostic modalities and technologies. A Delphi consensus was performed with experts from various disciplines who conducted a literature summary and voting process on 41 statements. Quality of evidence was evaluated using the grading of recommendations, assessment, development, and evaluation criteria. Consensus was reached for all the statements. The panel agreed with the definition and prevalence of esophageal and OD types. The role of endoscopy, high-resolution manometry, EndoFLIP, barium swallow and other imaging tests in evaluating esophageal dysphagia has reached overall strong agreement. Videofluoroscopic swallow study, alongside fiber-endoscopic evaluation of swallowing, as the methods of choice for the instrumental assessment of oropharyngeal dysfunction is a strong recommendation. Regarding treatment, a weak recommendation was achieved for the use of PPIs, calcium-channel blockers, nitrates, phosphodiesterase type 5 inhibitors, antidepressants or peppermint oil for the treatment of hypercontractile esophagus. A strong recommendation exists for endoscopic and surgical treatment of achalasia, while a weak recommendation is provided for other esophageal motility disorders. Regarding OD, a weak recommendation was achieved for swallow therapy, to improve swallowing mechanics, reduce symptoms, and enhance quality of life. Swallow therapy could be more effective when using validated assessment tools, consistent treatment parameters, and considering long-term follow-up. A multinational group of European experts summarized the current state of consensus on the definition, diagnosis, and management of dysphagia.This consensus was supported by a grant from United European Gastroenterology
Vacunar-se és estimar [cartell]
No full textVacunació; Covid-19; GripVaccination; Covid-19; FluVacunación; Covid-19; GripeAquest cartell, adreçat a la ciutadania, forma part de la campanya de vacunació contra la grip i la COVID-19 del 2025. Amb el missatge “Jo estimo la meva parella i el nen que vindrà”, anima tothom a vacunar-se com a mesura de prevenció i de protecció
Incessant Nonsustained Ventricular Tachycardia Unmasking Pulmonary Embolism
Get PDFAnticoagulation; Thrombosis; Ventricular tachycardiaAnticoagulació; Trombosi; Taquicàrdia ventricularAnticoagulación; Trombosis; Taquicardia ventricularBackground: Ventricular tachycardia (VT) is a malignant ventricular arrhythmia that requires emergent evaluation and treatment. Ischemic heart disease is the most common cause, but its etiology can involve many other possibilities.
Case summary: A 63-year-old man without structural heart disease presented with VT originating from the right ventricular outflow tract (RVOT), which turned into electrical storm despite antiarrhythmics. A computed tomography scan revealed bilateral acute pulmonary embolism (PE), and he showed favorable progress after its treatment, without further arrhythmias.
Discussion: This case highlights the importance of considering PE in the differential diagnosis of VT. Early detection and specific treatment are crucial for improving prognosis of PE, in addition to achieving effective control of the tachycardia by treating its trigger
7 passos per a cercar a Inquiro: descobreix la informació que tens al teu abast [cartell]
Get PDFCerca d'informació; Biblioteca; InstruccionsBúsqueda de información; Biblioteca; InstruccionesInformation search; Library; InstructionsAquest document explica com cercar informació a l'eina Inquiro de la Biblioteca de Ciències de la Salut de Catalunya
PHYOX3: Nedosiran Long-Term Safety and Efficacy in Patients With Primary Hyperoxaluria Type 1
Get PDFKidney stones; Long-term treatment; Primary hyperoxaluriaCàlculs renals; Tractament a llarg termini; Hiperoxalúria primàriaCálculos renales; Tratamiento a largo plazo; Hiperoxaluria primariaIntroduction
Primary hyperoxaluria type 1 (PH1) is a rare genetic disease characterized by oxalate overproduction in the liver, leading to hyperoxaluria, calcium oxalate stones, nephrocalcinosis, progressive chronic kidney damage, kidney failure, and systemic oxalate deposition. Nedosiran, an RNA interference therapy against lactate dehydrogenase subunit A mRNA, has been approved in the USA for treating patients with PH1 who are aged ≥ 9 years and have an estimated glomerular filtration rate (eGFR) ≥ 30 ml/min per 1.73 m2. PHYOX3 (NCT04042402) is an open-label extension trial evaluating the long-term safety and efficacy of once-monthly nedosiran in patients with primary hyperoxaluria (PH).
Methods
This PHYOX3 interim analysis includes 40 participants with PH1 from PHYOX1 (NCT03392896; n = 13) and PHYOX2 (NCT03847909; n = 27) trials. Efficacy was assessed using eGFR, urinary oxalate (Uox) excretion, and clinical outcomes. Safety and efficacy of nedosiran were assessed up to 42 months.
Results
At baseline, mean (SD) age was 24.9 (9.7) years (55% females; 42.5% White), mean (SD) eGFR was 80.0 (28.6) ml/min per 1.73 m2, and median number of kidney stone events (KSEs) was 3.0. The mean eGFR range throughout the study was 71.1 to 81.5 ml/min per 1.73 m2, and mean 24-hour Uox excretion declined by ˃ 60%, maintained from month 4 to month 42. Annualized stone event rate decreased from 0.40 at baseline to 0.20 (22 events/108.8 person-years). Eight participants experienced ≥ 1 serious adverse events (AEs), none associated with nedosiran. The most common nonserious treatment-related AEs were injection site reactions (6 participants; 15%). Four participants discontinued treatments (1 pregnancy and 3 withdrawals), and no deaths were reported.
Conclusion
Nedosiran was well-tolerated, reduced average Uox levels, reduced kidney stone occurrence, and maintained stable renal function for over 3 years.This study was funded by Novo Nordisk A/S