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BackgroundDespite clear recommendations supporting healthy lifestyle promotion interventions for the primary prevention of CVD in low-risk patients, a considerable number of these people continue to receive inappropriate statin prescriptions. The present study reports on the structured process based on theory and evidence carried out for the design of de-implementation strategies to reduce the inappropriate prescription of statins and to increase the promotion of healthy lifestyles, in CVD prevention practice of primary care professionals for patients with low cardiovascular risk.MethodsA phase I formative study following a structured theory-informed process combining the Theoretical Domains Framework (TDF) and the Behavior Change Wheel (BCW) was conducted, comprising: semi-structured interviews (n=5) with primary care professionals to delimitate and define the problem in behavioral terms; focus groups (4 groups with 21 physicians; 1 group with 6 patients) to identify the determinants of potentially inappropriate prescribing [PIP] of statins and healthy lifestyle promotion actions; mapping of behavioral change interventions operationalized as de-implementation strategies for addressing identified determinants; and consensus techniques for the prioritization of strategies based on perceived effectiveness, feasibility and acceptability.ResultsNumerous multilevel determinants of both PIP of statins and healthy lifestyle promotion embracing almost all of the TDF dimensions have been identified. Guided by the BCW established procedure, 13 potential de-implementation strategies have been mapped to identified determinants. Those assessed as potentially more feasible, acceptable and potentially effective by the professionals themselves were: 1) Information/knowledge dissemination strategies: a corporate dissemination campaign on “Abandonment of Low-Value Practices”; a Clinical Pathway for the primary prevention of CVD in low-risk patients, accompanied with audiovisual and paper-based training resources; 2) Strategies for presenting relevant information for decision-making: an audit/feedback system regarding CVD prevention practice performance indicators; and 3) Strategies for helping clinical decisions: reminders, alerts, and a decision support tool incorporated into the REGICOR CVD risk calculator in the electronic clinical record.DiscussionThe methodology established by the TDF/BWC for the design of behavior change interventions has been useful for the development of de-implementation strategies targeting the decision-making process of clinicians to favor the uptake of recommended clinical practice for CVD prevention in low-risk patients.TRIAL REGISTRATIONClinicaltrials.gov identifier: NCT04022850. Registered 17 July 2019, https://www.clinicaltrials.gov/ct2/show/NCT04022850

Background: The aim of this study was to analyze the appropriateness of the type of repair (open or endovascular) performed for abdominal aortic aneurysm (AAA) in five university hospitals in Spain, according to evidence-based recommendations. Methods: A multicenter, retrospective cross-sectional study of patients with AAA who underwent elective open surgical repair (OSR) or endovascular aneurysm repair (EVAR). Data were collected on demographic and clinical variables and type of surgical repair. A pair of vascular surgeons from each participating hospital performed a blinded assessment based on GRADE recommendations. The concordance between the two evaluators and the agreement between their evidence-based recommendation and the procedure performed were assessed. Results: A total of 186 patients were selected; 179 were included. Mean age was 72.5 years (standard deviation [SD], 8.4), mean Charlson Comorbidity Index (CCI) was 2.04 (SD, 1.9). OSR was performed in 53.2% (N.=99) and EVAR in 46.8% (N.=87) of cases. Overall, 65.9% (118/179) of interventions performed were considered appropriate: 50% (47/94) of OSRs and 83.5% (71/85) of EVARs. The patient characteristics were similar for all the hospitals, but the chosen surgical technique did show significant differences among these centers. There were no significant differences among the hospitals in the proportion of cases judged as appropriate, either overall (P=0.346) or for each type of procedure (P=0.531 and P=0.538 for OSR and EVAR, respectively). Conclusions: In this study, most of the AAA repairs performed were appropriate according to GRADE recommendations. A higher proportion of EVARs were considered appropriate than OSRs. Choice of AAA repair should be standardized using evidence-based clinical practice guidelines, while incorporating patient preferences, to reduce the existing variability and ensure appropriate selection of AAA repair technique.

ResumenAntecedentesLa biopsia renal preimplante puede aportar información útil evolutiva postrasplante.ObjetivoAnalizar el valor pronóstico de la biopsia renal de donantes de edad avanzada respecto al filtrado glomerular estimado MDRD-4 (FGe) al año del trasplante.MétodosEstudiamos a 124 receptores de trasplante renal de donantes fallecidos de ≥60 años, con biopsia renal preimplante. Los trasplantes fueron realizados en nuestro centro, entre marzo del 2008 y mayo del 2012. Las biopsias se valoraron según el baremo propuesto por O’Valle et al. y se categorizaron en 3 grupos: 0-3, 4-5, 6-8 puntos. Se descartaron los riñones con una puntuación >8. El 77% de los donantes tenía ≥70 años.ResultadosEl FGe medio (DE) del grupo 6-8 al año del trasplante: 38,5 (14,1) mL/min/1,73m2 fue menor que el del grupo 4-5: 46,3 (15,7) (p=0,03) y del grupo 0-3: 49,6 (12,5) (p=0,04). Se registraron 7 (19%) pacientes con FGe 8 points were discarded. A total of 77% of the donors were ≥70 years.ResultsOne year post-transplant, mean eGFR (SD) was lower in transplant recipients with 6-8 points (38.5 [14.1] mL/min/1.73m2) than in the group scoring 4-5 points (46.3 [15.7] [p=0.03]) and the group scoring 0-3 (49.6 [12.5] [P=.04]). Seven patients (19%) had eGFR

Background Arterial vascular events (AVE) are among the major causes of morbidity and mortality in patients with Systemic Lupus Erythematosus (SLE). Several studies have been carried out to identify the main factors related to AVE in this population. The ankle brachial index (ABI) is one of the tools currently used to identify patients at greater risk of arterial events in the general population; however it has been scarcely studied in patients with SLE. Objectives The objectives of this prospective cohort study were to determine the predictive value of the ABI for occurrence of AVE in patients with SLE and to identify other possible factors associated with an increased risk of AVE. Methods 216 patients with SLE were evaluated using an ABI and followed up for 5 years. Pathological ABI is considered an ABI Results During follow-up, 4/216 (1.8%) patients were lost to follow-up. 18 AVE were identified in 17 patients, with one patient having 2 episodes of angina requiring angioplasty (4 coronary events, 11 cerebrovascular events, 2 peripheral arterial disease events and 1 sudden death) and 14 deaths (6 per AVE or their sequelae, 4 due to neoplasias and 4 due to cardio-respiratory pathology). In the competitive risk regression analysis, independent predictors of higher risk of AVE were identified: pathological ABI (subhazard ratio (SHR) 3.51, 95% confidence interval 0.96–12.79, p=0.057), family history of AVE (SHR 6.3, 95% CI 1.97–20.21, p=0.002), cumulative total prednisone (grams) (SHR 1.02, 95% CI 1.01–1.04, p=0.004) and a history of arterial thrombosis (SHR 4.60, 95% CI 1.45–14,59, p=0.010).Female gender was a protective factor for the occurrence of AVE (SHR 0.12, 95% CI 0.04–0.40, p Conclusions Being male, having a higher cumulative dose of prednisone, having a family history of early vascular disease and having suffered previous arterial thrombosis are independent risk predictors of an AVE in patients with SLE. Having abnormal ABI, even without statistical significance, showed a marked tendency to increase this risk despite the low number of events recorded in the studied cohort. Disclosure of Interest None declared

EuroNeoStat is a European project, financed entirely by one million Euros from the European Commission Health and Consumer Protection Directorate General (DG Sanco), within the VI Research Framework Programme for 2006 to 2008. Neonatal units from 23 European countries work together on this project, which is led from our country. Its overall objective is to create a European information system that monitors the shortand long-term outcomes of extremely low birth-weight infants (ELBWI) attended at the units taking part, in order to improve the quality and safety of care provided and so improve their development. Currently, premature birth must be a health priority, given its high prevalence and its grave family, social, individual and health-care consequences, as well as its economic impact. These babies not only require long stays in neonatal intensive care units (NICUs), but often require rehospitalisation, along with multiple preventive, therapeutic and rehabilitatory interventions, which drain the always limited health-care resources available. All this means that this project is extremely relevant both for health-care delivery and in social and economic terms. Although the end aim of Perinatology is to avoid premature birth, this target has not been attainable. In fact, the same as in Europe as a whole1, premature birth rates have increased in our country, such that in three decades they have almost doubled (from 4-5 % to the current 7-8 %)2. In addition, ELBWI, under 1,500 grams at birth, though only accounting for 1-2% of all births, have high specific mortality (15-20 %) and morbidity (10-20 %), which means they contribute greatly both to neonatal and child mortality3 and to childhood disability. It should also not be forgotten that, although these rates depend on maternal health and the perinatal care received, specific morbi-mortality is the outcome, among other factors, of the quality of neonatal care. In NICUs, monitoring and life-support techniques have not only increased survival4, but have avoided some of these patients suffering injuries that would lead eventually to long-term disability. Despite this, an overall 10% of ELBWI are gravely disabled; and a further 10 %, moderately disabled5,6. In addition, 20-30% of the most immature babies have a cognitive or attention deficiency or delayed psycho-motor development7. If the outcomes are to be improved, then those factors of risk that can be modified must be identified, the care process needs to be analysed and the results for one unit, region or country need to be compared with reference populations. In addition to intra-institution analysis, as long as explicit and homogeneous indicators and criteria are followed, inter-institution comparisons can also be conducted8.

The aim of this study was to investigate the main characteristics of non-vaccinated pregnant women who were hospitalised for influenza A (H1N1) pdm09 pandemic versus pregnant women hospitalised for non-influenza-related reasons in Spain, and to characterise the clinical presentation of the disease in this population to facilitate early diagnosis and future action programmes. Understanding influenza infection during pregnancy is important as pregnant women are a high-risk population for increased morbidity from influenza infection. We investigated the socio-demographic and clinical features of 51 non-vaccinated, pregnant women infected with the pandemic influenza A (H1N1) virus in Spain (cases) and compared them to 114 controls (non-vaccinated and non-infected pregnant women) aged 15–44 years. Substantial and significant odd ratios (ORs) for pandemic influenza A (H1N1) were found for the pregnant women who were obese compared with controls (body mass index > 30) (OR 3.03; 95 % confidence intervals 1.13–8.11). The more prevalent symptoms observed in pandemic influenza-infected pregnant women were high temperature, cough (82.4 %), malaise (80.5 %), myalgia (56.1 %), and headaches (54.9 %). Our results suggest that the initial symptoms and risk factors for infection of pregnant women with the influenza A (H1N1) pdm09 virus are similar to the symptoms and risk factors for seasonal influenza, which make early diagnosis difficult, and reinforces the need to identify and protect high-risk groups.

To evaluate the efficacy of sentinel node biopsy (SNB) in oral squamous cell carcinoma (OSCC).A prospective study of a cohort of 25 consecutive patients with OSCC anatomopathological confirmation through biopsy, without oncological pre-treatment, in clinical stage T1-T4N0, of these 25 patients 14 were T1-T2N0. The absence of regional disease (N0) was determined by means of clinical exploration and cervical tomography (CT). To establish the overall sensitivity of the technique, a meta-analysis was carried out of 10 series published to February 2005 where SNB had been applied to head and neck cancer, adding our 14 T1-T2N0 cases, thus making a total of 260 patients.Identification by SNB was accurate in 96% of the 25 cases, with a sensitivity of 66.7%. Analyzing only the T1-T2N0 cases (n=14), the accuracy was 100% with a sensitivity of 1 (CI 95%, 0.29-1.00). The overall sensitivity was 93%. The accuracy in identifying the sentinel node varied between 66% and 100%. The SN was identified in 251 of 260 cases, of those, 71 were true positive, 5 false negative and 175 true negative. The overall sensitivity was 93.4% (CI 95%, 85.3-97.8), with a specificity of 100% (CI 95%, 0.98-100). The weighted negative probability quotient was 0.176 (CI 0.103-0.301) and that of positive probability 24.75 (CI 95%, 10.8-56.71). The weighted diagnostic odds ratio was 183.71 (CI 95%, 59.36-568.56). If we accept that the prevalence of hidden regional disease is 30%, a negative sentinel node has 5% possibility of having hidden disease.Our data provide a certain degree of evidence that, due to its high sensitivity, the SNB procedure can be applied to the initial stages of OSCC.

Heparin remains the drug most commonly used for anticoagulation in continuous renal replacement therapies (CRRTs). However, in patients with hypercoagulability, heparin is insufficient or, in cases with an increased risk of bleeding or thrombocytopenia, it may be contraindicated. Epoprostenol, a potent vasodilator, antithrombotic and antiplatelet agent, could be an alternative.We studied the records of patients treated under continuous venovenous hemodiafiltration in an academic tertiary hospital of 900 beds, between January 2000 and June 2003. Epoprostenol was prescribed to patients with (i) filter hypercoagulability, defined as consumption of 2 or more filters in the last 24 hours; (ii) low platelet count; or (iii) recent severe hemorrhage.Thirty-eight out of 248 (15%) patients who were under CRRT received epoprostenol for more than 72 hours. Epoprostenol was indicated due to filter hypercoagulability in 48%, thrombocytopenia in 68% (7 patients both) and hemorrhage in 3% of cases. The overall time for epoprostenol therapy was 9,749 hours. The mean filter duration previous to epoprostenol was 23 +/- 12 hours and after administering this drug 38.2 +/- 11.9 hours (p = 0.0001). In 6 patients, heparin and epoprostenol were simultaneously administered. The adverse effects were hemorrhage, which presented in 7 patients (18%) and a fall in blood pressure in another 7 (18%), which recovered in the next 24 hour after starting treatment. Cost analysis demonstrates some advantage with epoprostenol in patients with increased tendency to clotting.Epoprostenol may be safely used to prevent clotting of the extracorporeal circuits, either alone in patients with thrombocytopenia and/or increased risk of bleeding, or in combination with heparin in states of hypercoagulability.

Aquesta tesi té com a principals objectius:1- Identificació de nous substrats de cdk2 en diferents models cel·lulars: cèl·lules HeLa, hepatòcits normals activats a proliferar mitjançant una hepatectomia parcial, limfòcits humans normals activats a proliferar, i la línia limfoide Namalwa.2- Localització intranuclear de proteïnes que participen en el control del cicle cel·lular en dos models de proliferació un normal i l'altre transformat: hepatòcits normals activats a proliferar mitjançant una hepatectomia parcial, i la línia cel·lular transformada d'origen humà HeLa.3- Anàlisi dels mecanismes d'activació de la cdk4 i la cdk2 durant la regeneració hepàtica.

To assess the agreement between tubal patency assessed by laparoscopy with chromopertubation and by hysterosalpingography using contrast media.University Medical School.314 consecutive women subjected to laparoscopy and hysterosalpingography for an infertility study.Prospective study.Chromopertubation using Methylen blue dye, performed on days 20-24. Hysterosalpingography performed on days 7-10 with water soluble contrast.Kappa coefficient calculation.Kappa coefficient ranged from 0.40 to 0.36, depending on the categories analyzed, corresponding to a fair agreement.The diagnosis of tubal factor requires that both tubal patency tests (Hysterosalpingography and laparoscopy) show an abnormal patency. When one of the aforementioned tests is normal, performing the second one has little clinical advantage. However, it is suggested that when there is a discordant patency the pregnancy rates could be somewhat reduced.

Background: We showed that a predictive model with eight perinatal risk factors correctly predicts pre-discharge mortality (ESPR 2009). We aim to predict neonatal survival without severe IVH and/ or PVL. Methods: In 2006-07, EuroNeoNet collected data from 5,270 VLBW/ VLGA infants (< 32 weeks), admitted before day 28 to 65 NICUs from 14 European countries. A combined outcome for postdischarge survival without grades3,4 IVH and cystic PVL was used. Regression models to predict survival and combined outcome were developed adjusted for perinatal factors by step-wise selection. Calibration by Hosmer-Lemeshow and discrimination by area under ROC curve was used, latter validated on a different sample. Models to predict combined outcome adjusted by birthweight and/or gestation were also performed. Comparisons between models were based on non-parametric tests over ROC curves. Results: Mean(±SD) gestation was 28.6(2.7) weeks and birthweight 1,178(382) g. Adding the need for resuscitation at birth (more than just O2 therapy) to previously developed model for survival (gestation, birthweight, gender, prenatal-steroiduse, delivery-mode, 1 and 5-min Apgar scores and major congenital anomalies) correctly predicted survival without severe IVH and PVL (AUC: 0.825; 95%;CI 0.81-0.84; HL validation sample: HL95%CI:0.807-0.85). This model performed better than those based on birthweight and/or gestation. Conclusion: Score based on nine initial risk factors adjusted for neonatal survival without severe IVH and PVL can be used as a short-term surrogate for risk of adverse developmental outcome at followup. The score could be used to measure quality improvement initiatives.