Eugenio Fernández Vicente

Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study.

BACKGROUND The effect of obstructive sleep apnoea-hypopnoea as a cardiovascular risk factor and the potential protective effect of its treatment with continuous positive airway pressure (CPAP) is unclear. We did an observational study to compare incidence of fatal and non-fatal cardiovascular events in simple snorers, patients with untreated obstructive sleep apnoea-hypopnoea, patients treated with CPAP, and healthy men recruited from the general population. METHODS We recruited men with obstructive sleep apnoea-hypopnoea or simple snorers from a sleep clinic, and a population-based sample of healthy men, matched for age and body-mass index with the patients with untreated severe obstructive sleep apnoea-hypopnoea. The presence and severity of the disorder was determined with full polysomnography, and the apnoea-hypopnoea index (AHI) was calculated as the average number of apnoeas and hypopnoeas per hour of sleep. Participants were followed-up at least once per year for a mean of 10.1 years (SD 1.6) and CPAP compliance was checked with the built-in meter. Endpoints were fatal cardiovascular events (death from myocardial infarction or stroke) and non-fatal cardiovascular events (non-fatal myocardial infarction, non-fatal stroke, coronary artery bypass surgery, and percutaneous transluminal coronary angiography). FINDINGS 264 healthy men, 377 simple snorers, 403 with untreated mild-moderate obstructive sleep apnoea-hypopnoea, 235 with untreated severe disease, and 372 with the disease and treated with CPAP were included in the analysis. Patients with untreated severe disease had a higher incidence of fatal cardiovascular events (1.06 per 100 person-years) and non-fatal cardiovascular events (2.13 per 100 person-years) than did untreated patients with mild-moderate disease (0.55, p=0.02 and 0.89, p<0.0001), simple snorers (0.34, p=0.0006 and 0.58, p<0.0001), patients treated with CPAP (0.35, p=0.0008 and 0.64, p<0.0001), and healthy participants (0.3, p=0.0012 and 0.45, p<0.0001). Multivariate analysis, adjusted for potential confounders, showed that untreated severe obstructive sleep apnoea-hypopnoea significantly increased the risk of fatal (odds ratio 2.87, 95%CI 1.17-7.51) and non-fatal (3.17, 1.12-7.51) cardiovascular events compared with healthy participants. INTERPRETATION In men, severe obstructive sleep apnoea-hypopnoea significantly increases the risk of fatal and non-fatal cardiovascular events. CPAP treatment reduces this risk.

Tongue‐Base Suspension in Conjunction with Uvulopalatopharyngoplasty for Treatment of Severe Obstructive Sleep Apnea: Long‐Term Follow‐Up Results

Objectives/Hypothesis: To evaluate the usefulness of tongue‐base suspension (TBS) in addition to uvulopalatopharyngoplasty (UPPP) in the treatment of obstructive sleep apnea syndrome (OSAS).

Upper airway and systemic inflammation in obstructive sleep apnoea.

Obstructive sleep apnoea (OSA) is associated with pharyngeal inflammation, but the coexistence of systemic inflammation is controversial. This study investigated whether local and systemic inflammatory biomarkers are related in patients with OSA. An uncontrolled extension to the study assessed the response to effective treatment. We recruited 89 patients with OSA (apnoea/hypopnoea index (AHI) ≥5 events·h−1), 28 snorers and 26 healthy controls. Pharyngeal lavage (PHAL) and plasma samples were collected at baseline and after a 1-year follow-up. Inflammatory cells were evaluated by flow cytometry; interleukin (IL)-6, IL-8 and tumour necrosis factor-α were evaluated by immunoassay. In PHAL, CD4+ T-cells, IL-6 and IL-8 were higher in OSA patients than in snorers or healthy controls (p<0.05). The AHI correlated with CD4+, IL-6 and IL-8 in PHAL (all p-values <0.05). There were no differences in the inflammatory biomarkers in plasma between the study groups and no relationship between plasma and PHAL biomarkers. Biomarkers decreased significantly in PHAL but not in plasma after 1 year of therapy with continuous positive airway pressure or surgery. In patients with OSA, increased levels of inflammatory biomarkers were found in PHAL, which were reduced with effective treatment. No simultaneous increase in plasma inflammatory biomarkers was found. Pharyngeal lavage, but not plasma, shows high levels of inflammatory markers in OSA that were normalised by treatment http://ow.ly/pKYd301hs6A

Maturity Model for IT Service Outsourcing in Higher Education Institutions

The current success of organizations depends on the successful implementation of Information and Comunication Technologies (ICTs). Good governance and ICT management are essential for delivering value, managing technological risks, managing resources and performance measurement. In addition, outsourcing is a strategic option which complements IT services provided internally in organizations. This paper proposes the design of a new holistic maturity model based on standards ISO/IEC 20000 and ISO/IEC 38500, the frameworks and best practices of ITIL and COBIT, with a specific focus on IT outsourcing. This model is validated by practices in the field of higher education, using a questionnaire and a metrics table among other measurement tools. Models, standards and guidelines are proposed in the model for facilitating adaptation to universities and achieving excellence in the outsourcing of IT services. The applicability of the model allows an effective transition to a model of good governance and management of outsourced IT services which, aligned with the core business of universities (teaching, research and innovation), affect the effectiveness and efficiency of its management, optimizes its value and minimizes risks.

EFQ_TIL: Relationship Model Between ITIL and EFQM to Assure Service Quality in IT Processes

IT service management (ITSM) was established based on modern international standards such as ISO/IEC 20000 and ITIL. One objective of good management of IT services must be to provide adequate quality management. Currently the application of appropriate models for government and IT management is one of the priorities in the area of IT in organizations, and in this sense, the use of action frameworks, for example, ITIL, is essential. In its implementation it is necessary to consider, among other things, improving the quality of the processes that must be measured not only with tools or methodologies own IT but also with those used in the organization in order to measure processes in general. But how, exactly, do you measure fitness for use or purpose? In this sense, this chapter addresses the measurement of quality of processes in the implementation of ITIL in an organization using the EFQM model, in order, first, to make a proper correlation of ITIL processes and criteria EFQM and, second, to explore possible deployment scenarios that maximize the results of evaluations conducted by EFQM.

Cloud Management and Governance: Adapting IT Outsourcing to External Provision of Cloud-Based IT Services

Outsourcing is a strategic option which complements IT services provided internally in organizations. The maturity model for IT service outsourcing (henceforth MM-2GES) is a new holistic maturity model based on standards ISO/IEC 20000 and ISO/IEC 38500, and the frameworks and best practices of ITIL and COBIT, with a specific focus on IT outsourcing. MM-2GES allows independent validation, practical application, and an effective transition to a model of good governance and management of outsourced IT services. Cloud computing is a new model for provisioning and consuming IT services on a need and pay-per-use basis. This model allows the IT systems to be more agile and flexible. The external provision of cloud-based services as part of Cloud computing appears as an evolution of traditional outsourcing, due to the emerging technologies related to the provision of IT services. As a result of technological developments, traditional outsourcing and external provision of cloud-based services, share common characteristics, but there are also some differences. This paper adapts MM-2GES to external provision of cloud-based services, from the point of view of the customer. This way, the applicability of the model can be implemented in organizations that have both models traditional IT outsourcing and cloud-based services provided externally, in order to achieve excellence in governance and management of all kind of IT services provided externally to organizations.

Applicability of the Maturity Model for IT Service Outsourcing in Higher Education Institutions

Outsourcing is a strategic option which complements IT services provided internally in organizations. This study proposes the applicability of a new holistic maturity model based on standards ISO/IEC 20000 and ISO/IEC 38500, and the frameworks and best practices of ITIL and COBIT, with a specific focus on IT outsourcing. This model allows independent validation and practical application in the field of higher education. In addition, this study allows to achieve an effective transition to a model of good governance and management of outsourced IT services which, aligned with the core business of universities, affect the effectiveness and efficiency of its management, optimizes its value and minimizes risks.

09:32: GAHM Surgery for Severe OSA

10:14 Reverse PCR for Diagnosis of Sentinel Node of H&N Cancer Hugo Fontan Kohler, MD (presenter); Carlos Takahiro Chone, MD, PhD; Agricio Nubiato Crespo, MD, PhD; Sara Costa, MD; Elba Etchehebere, MD; Eduardo Camargo, MD; Albina Altemani, MD OBJECTIVES: 1. Diagnose lymphatic metastasis of H&N cancer by cytokeratin analysis. 2. Compare molecular analysis with pathological analysis. METHODS: Study design: Comparison of patients with N0 necks submitted to sentinel node biopsy against historic controls of both N0 and N stages. Year: 2006. Disease studied: Squamous cell carcinoma, primary site in oral cavity or larynx. Setting: University hospital. Intervention: Reverse PCR study of cytokeratin expression in lymphnodes. Outcome: Sensibility and specificity of PCR reaction versus pathological analysis. Independent variables: Positive marking. Statistical methods: Frequencies determination, sensibility, specificity and predictive values. RESULTS: In this study, determination of CK20 gene expression by nested RT-PCR improved in 17% of cases the rate of detection of lymphatic micrometastasis. CONCLUSIONS: The technique has a sensibility, specificity, and accuracy of 100% compared with positive and negative controls of tissue with SCC.