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Transitional Pain Service: An Update
No full textPurpose of Review Chronic Postsurgical Pain (CPSP) and the risk for long-term opioid dependency are known complications following major surgery. The idea of Transitional Pain Service (TPS) has been introduced as an interdisciplinary setting to manage pain in the perioperative continuum. We expand on the basic framework and principles of TPS and summarize the current evidence of the TPS and possible interventions to adress postoperative pain. Areas of future work in TPS-related research are discussed. Recent Findings Several studies support the effectiveness of TPS in reducing opioid consumption in the perioperative period and following discharge. Some studies also show an improvement in functional outcome with TPS with patients reporting lower pain severity and pain interference. Summary The TPS aims to halt the progress of acute postoperative pain to CPSP by providing longitudinal support with patient-centered care. While some studies suggest a positive impact of TPS implementation in terms of reduction in postoperative opioid consumption and improvement of some functional outcomes, direct evidence in terms of reduction in the incidence of CPSP is still missing. The cost-effectiveness of TPS and the expansion of TPS through e-health services and digital applications also need to be evaluated.University of Bern3.7 Q2 JCR 20220.767 Q1 SJR 2023No data IDR 2022UE
Agrupación familiar de anomalías coronarias mediante signo de RAC
No full textSin financiaciónNo data JCR 20220.593 Q2 SJR 20230,03 C4 IDR 2022UE
Takotsubo syndrome outcomes predicted by thyroid hormone signature: insights from cluster analysis of a multicentre registry
No full textBackground: Recently, abnormal thyroid function was shown to be common in patients with Takotsubo syndrome (TTS), being classified into “endocrine-type” and “stress-type” responses. The aim of this study was to investigate the association between thyroid homeostasis and TTS in a larger international registry.
Methods: In total 288 patients with TTS were enrolled through the GEIST multicentre registry from Germany, Italy and Spain. Thyrotropin (TSH), free T4 (FT4) and free T3 (FT3) concentrations were analysed at admission. Data were collected both retrospectively and prospectively from 2017 onwards. Primary endpoints included in-hospital and all-cause fatality, determined by cluster analysis using an unsupervised machine learning algorithm (k-medoids).
Findings: Three clusters were identified, classifying TTS with low (TSLT), high (TSHT) and normal (TSNT) thyroid output, based on TSH and FT4 levels in relation to the median thyroid’s secretory capacity (SPINA-GT). Although TSH and FT4 concentrations were similar among survivors and non-survivors, these clusters were significantly associated with patient outcomes. In the longitudinal Kaplan–Meier analysis including in- and out-of-hospital survival, the prognosis related to concentrations of TSH, FT4, and FT3 as well as SPINA-GT, deiodinase activity (SPINA-GD) and clusters. Patients in the TSHT cluster and with cardiogenic shock had a lower initial left ventricular ejection fraction (LVEF).
Interpretation: This study suggests that thyroid hormones may impact the evolution and prognosis of TTS. The findings indicate that thyroid-derived biomarkers may help identify high-risk patients and pave the way for novel personalized and preventive therapeutic options.Sin financiación11.1 Q1 JCR 20223.193 Q1 SJR 2023No data IDR 2022UE
Renal impairment and outcome in Takotsubo syndrome: Insights from a national multicentric cohort
No full textntroduction: Data on the association between kidney function and Takotsubo syndrome (TTS) outcomes are scarce and conflictive.
Objective: To assess the impact of chronic kidney disease (CKD) and acute renal failure (ARF) in patients with TTS.
Material and methods: Patients from the prospective nation-wide (RETAKO) registry were included and divided into quartiles of maximum creatinine (Cr) level during hospitalization.
Results: The prevalence of CKD and ARF in the whole RETAKO cohort was 5.4% and 11.7%, respectively. Compared to Q1 (Cr 1.1) had lower left ventricular ejection fraction on admission (38.5 ± 12 vs 43.3 ± 11.3, p = 0.002) and higher bleeding rates during hospitalization (6.7% vs 2%, p = 0.005). In addition, compared to Q1, Q4 patients have a greater incidence of cardiogenic shock (17.3% vs 5.6%, p < 0.001), and a higher rate of 5-year all-cause death and major adverse cardiovascular events (31.5% vs 15.8%, p < 0.001 and 22.5% vs 9.3%, p < 0.001, respectively).
Conclusions: TTS patients with CKD have a higher incidence of ARF and exhibit greater Cr on admission, which were linked with higher rates of cardiogenic shock, bleeding during hospitalization as well as major adverse cardiovascular events and all-cause death during a 5-year follow-up.Sociedad Española de CardiologíaMayo Clinic3.5 Q1 JCR 20221.126 Q1 SJR 2023No data IDR 2022UE
Age-Related Differences in Takotsubo Syndrome: Results From the Multicenter GEIST Registry
No full textBACKGROUND: The role of age in the short‐ and long‐term prognosis of takotsubo syndrome (TTS) is controversial. The aim of the present study was to evaluate age‐related differences and prognostic implications among patients with TTS.
METHODS AND RESULTS: In total, 2492 consecutive patients with TTS enrolled in an international registry were stratified into 4 groups (<45, 45–64, 65–74, and ≥75 years). The median long‐term follow‐up was 480 days (interquartile range, 83–1510 days). The primary outcome was all‐cause mortality (in‐hospital and out‐of‐hospital mortality). The secondary end point was TTS‐related in‐hospital complications. Among the 2479 patients, 58 (2.3%) were aged <45 years, 625 (25.1%) were aged 45 to 64 years, 733 (29.4%) were aged 65 to 74 years, and 1063 (42.6%) were aged ≥75 years. Young patients (<45 years) had a higher prevalence of men (from youngest to oldest, 24.1% versus 12.6% versus 9.7% versus 11.4%; P<0.01), physical triggers (46.6% versus 27.5%, 33.9%, and 38.4%; P<0.01), and non‐apical forms of TTS (25.9% versus 23.7%, 12.7%, and 9%; P<0.01) than those aged 45 to 64, 65 to 74, and ≥75 years. During hospitalization, young patients experienced a higher rate of in‐hospital complications (32.8% versus 23.4%, 27.4%, and 31.9%; P=0.01), but in‐hospital mortality was higher in the older group (0%, 1.6%, 2.9%, and 5%; P=0.001). Long‐term all‐cause mortality was significantly higher in the older cohort (5.6%, 6.4%, 11.3%, and 22.3%; log‐rank P<0.001), as was long‐term cardiovascular mortality (0%, 0.9%, 1.9%, and 3.2%; log‐rank P=0.01).
CONCLUSIONS: Young patients with TTS have a typical phenotype characterized by a higher prevalence of male sex, non‐apical ballooning patterns, and in‐hospital complications. However, in‐hospital and long‐term mortality are significantly lower in young patients with TTS.Sin financiación5.4 Q2 JCR 20222.126 Q1 SJR 2022No data IDR 2022UE
Presence of Differences in the Radiofrequency Parameters Applied to Complex Pressure Ulcers: A Secondary Analysis
No full textAbstract: Background: Pressure ulcers are a public health problem given the impact that they have on morbidity, mortality and the quality of life and participation of patients who suffer from them.Therefore, the main objective of this study was to evaluate the presence of differences in the radiofrequency parameters applied to complex pressure ulcers throughout the sessions and between the right and left leg. As a secondary objective, the subjective perceptions of the effects of the treatment by both the patients and the practitioner were analyzed. Methods: We performed a secondary analysis of data from a prospective study involving 36 patients from the Hospital de Guadarrama in Madrid, Spain, who presented ulcers in the lower limbs. Ten treatment sessions of radiofrequency were administered with a frequency of one session/week, collecting the data referring to the variables in each of the sessions. The main outcome variables were the radiofrequency parameters automatically adjusted in each session and that referred to the frequency (Hz), maximum and average power (W), absorbed energy by the ulcer (J/cm2) and temperature (◦C) reached by the tissues. On the other hand, the subjective perception of the results was evaluated using the Global Response Assessment (GRA), a Likert-type scale that scores the treatment results from 1 (significantly worse) to 5 (significantly better). Likewise, the satisfaction of both the patients and the professional were evaluated using a 10-point numerical scale. Results: The ANOVA test showed significant differences (p < 0.05) throughout the sessions except in patient satisfaction. The ANOVA test showed significant differences (p < 0.05) between both legs and over time in all parameters except for frequency. The presence of significant differences (p < 0.05) was observed over time between legs compared to the initial values in the absorbed energy and in temperature, with higher final values in the absorbed energy in the left leg compared to the right (26.31 ± 3.75 W vs. 17.36 ± 5.66 W) and a moderate effect on both (R2 = 0.471 and 0.492, respectively). The near absence of changes in the satisfaction of both the patients and the professional was observed, while the score in the GRA decreased continuously throughout the sessions. Conclusions: Radiofrequency parameters are indicative of an improved clinical response to ulcers. In addition, higher radiofrequency exposure increases healing capacity. However, the subjective perception of treatment outcomes worsened, which may be related to the chronic nature of the ulcers, leading to patients’ expectations not being met.Sin financiaciónNo data SPI 2022UE
New developments in infective endocarditis
No full textLa endocarditis infecciosa es una enfermedad en continuo cambio. Los pacientes atendidos en la actualidad en nada se parecen a los de hace unas décadas: son de más edad, tienen más comorbilidades y más episodios asociados con los cuidados sanitarios. Además, han surgido nuevos grupos de pacientes con formas de endocarditis que antes no existían, como las que afectan a portadores de implantes percutáneos de prótesis valvulares. Las técnicas para el diagnóstico de la enfermedad también han cambiado. Aunque las ecocardiografías transtorácicas y transesofágicas siguen siendo las pruebas de imagen más utilizadas, cada vez son más frecuentes otras técnicas, como la ecografía transesofágica tridimensional, la tomografía computarizada cardiaca y las pruebas de medicina nuclear (PET-TC y SPECT-TC) tanto en el diagnóstico de la enfermedad como en sus complicaciones. En los últimos años también ha habido novedades muy significativas respecto al tratamiento antibiótico. En la actualidad contamos con diferentes estrategias de tratamiento para acortar la fase hospitalaria de pacientes concretos y reducir las complicaciones asociadas con el ingreso, mejorar la calidad de vida de los pacientes y sus familiares y reducir el coste sanitario relacionado con la enfermedad. En esta revisión, se comentan las principales novedades epidemiológicas, diagnósticas y terapéuticas de la endocarditis infecciosa.Infective endocarditis is a continually evolving disease. Present-day patients differ significantly from those treated a few decades ago: they tend to be older and have more comorbidities and health care-related episodes, while new groups of patients have emerged with new types of endocarditis, such as those affecting patients with percutaneous valve prostheses. There have also been changes in diagnostic techniques. Although transthoracic and transesophageal echocardiography are still the most commonly used imaging modalities, other techniques, such as 3-dimensional transesophageal ultrasound, cardiac computed tomography, and nuclear medicine tests (PET/CT and SPECT/CT), are increasingly used for diagnosing both the disease and its complications. In recent years, there have also been significant developments in antibiotic therapy. Currently, several treatment strategies are available to shorten the hospital phase of the disease in selected patients, which can reduce the complications associated with hospitalization, improve the quality of life of patients and their families, and reduce the health care costs of the disease. This review discusses the main recent epidemiological, diagnostic and therapeutic developments in infective endocarditis.Instituto de Salud Carlos III (PI22/00459)Gerencia Regional de Salud de Castilla y León (GRS 2657/A/22)5.9 Q1 JCR 20220.593 Q2 SJR 2023No data IDR 2022UE
Impact of Spectators, League and Team Ability on Home Advantage in Professional European Basketball
No full textOur aim in this study was to examine the impact of fans (vs. no fans), geographical location of league, and team ability on home winning percentage (HW%) or home advantage (HA) in professional European basketball. Data were collected from five prestigious professional, national basketball leagues within Europe (Spain, Germany, Italy, Greece and Israel) across 16 regular seasons (2005-2006 to 2020-2021). We conducted comparisons between matches with and without fans, location of leagues, team ability (High, Medium, Low), and combinations of these factors via non-parametric tests (e.g., Mann-Whitney tests, Kruskal-Wallis). We found significantly greater HA during matches with fans for leagues in Germany (p = .001), Italy (p = .012) and Spain (p = .002). For matches with fans, HA and HW% were significantly different between several, but not all, leagues for high (p < .05), medium (p < .05) and low (p < .02) team abilities. In conclusion, HA and HW% were enhanced by spectator attendance, with this phenomenon varying by location/region and team ability. Consideration of these multiple contextual factors may assist coaches and sport organizations to develop key strategies for enhanced team success.Sin financiación1.4 Q4 JCR 20230.557 Q3 SJR 2023No data IDR 2023UE