Pedro Vazquez-Ferreiro

Intraocular lens dislocation in pseudoexfoliation: a systematic review and meta-analysis.

To evaluate the impact of pseudoexfoliation syndrome on intraocular lens (IOL) dislocation after phacoemulsification cataract surgery and explore possible associations related to surgical technique.

Adverse Effects of Collagenase in the Treatment of Dupuytren Disease: A Systematic Review

BackgroundCollagenase clostridium histolyticum (CCH) has proven to be both safe and effective in the treatment of Dupuytren disease (DD). The medium-term outcomes are similar to those achieved with surgery, and most adverse effects are self-limiting and considered to be mild or moderate.ObjectiveOur objective was to conduct a systematic review of the adverse effects of CCH in DD since the release of the drug to evaluate the incidence, severity, classification, and definitions of these effects.MethodsWe analyzed the literature in terms of modifications to the original treatment protocol and grouped adverse effects according to their pathophysiological origin.ResultsWe included 28 clinical studies and five case reports or case series analyzing 4456 patients with a mean age of 63.6 years. Mean follow-up was 7.07 months (range 3–24); the mean number of patients per study was 148 (range 5–1082). The studies did not classify the adverse effects they reported into groups. The most common effects were peripheral edema (54.4%), bruising (42.9%), and upper limb pain (28.3%). Significant biases were observed for use of terminology, demarcation of sites of involvement, severity criteria, and assessment methods.ConclusionA simpler and clearer consensus-based classification system would enable better evaluation and comparison of the adverse effects of CCH in the treatment of DD. Consideration of inflammatory phenomena as part of the drug’s mechanism of action would significantly reduce overall rates of adverse effects.

Short-Term Cost-Utility Analysis of Collagenase Versus Fasciectomy for Dupuytren Contracture

The use of collagenase clostridium histolyticum (CCH) provides advantages of noninvasive treatments (rapid recovery, low incidence of severe complications, and minimal alteration of the skin), while fasciectomy (FSC) provides removal of the diseased tissue and a lower recurrence rate at. CCH is increasingly being used in hand care units (Schulze and Tursi 2014). Creating protocols adapted to small surgery units, or even outpatient units, has allowed optimizing both the clinical and economic results of its use (Sanjuan Cervero et al. 2013). Various studies have assessed the costs associated with treatment of Dupuytren contracture (DC) with regard to a single technique (De Salas-Cansado 2013; Sanjuan-Cervero 2013; Atroshi 2014; Eckerdal 2014). Very few have evaluated the efficiency of CCH compared to fasciectomy (Chen 2011; Baltzer and Binhammer 2013). So far, no studies regarding cost-effectiveness have been performed in Europe that could help in the decision-making process in treating DC.

Pain Associated With Treatment of Dupuytren Contracture With Collagenase Clostridium histolyticum

PURPOSE The primary objective of this study was to quantify the degree of pain associated with collagenase Clostridium histolyticum (CCH) injection and to determine whether it is related to other factors in the intervention. METHODS A prospective study of 135 patients was performed to evaluate pain at 3 points during treatment: (1) after CCH injection, using a numerical rating scale (NRS), (2) a binary (positive/negative) assessment before manipulation 24 hours after CCH and after removing the bandage, and (3) after joint manipulation performed with wrist block anesthesia. RESULTS The average NRS for pain during infiltration was 4.7. Pain was present before manipulation in 52.6% of patients. Pain from manipulation showed an average NRS score of 3.6. The amounts of pain at CCH infiltration, pain after 24 hours, and pain from the manipulation were correlated because patients who experienced pain during CCH infiltration were more likely to report experiencing pain during manipulation. CONCLUSIONS Collagenase Clostridium histolyticum injection for treating Dupuytren contracture can be a painful process. There is a clear relationship between a patients level of pain during injection of CCH and the likelihood that the patient will experience pain during manipulation, even with the use of local anesthesia. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.

Intraoperative complications of phacoemulsification in pseudoexfoliation: Metaanalysis

&NA; This review analyzed the effect of pseudoexfoliation (PXF) syndrome on the risk for surgical complications during phacoemulsification. Peer‐reviewed literature in Medline, Embase, Lilacs, Web of Science, and Cochrane databases was systematically searched, along with gray literature in the Teseo and National Institutes of Health clinical trials database. Clinical trial, cohort, case‐control, and cross‐sectional studies comparing phacoemulsification complications in patients with and without PXF were identified, and 22 of 30 studies were selected for analysis. Odds ratios (ORs) for posterior capsule rupture or zonular dialysis were calculated and pooled using random‐effects models. A random‐effects meta‐regression model was also generated. Using the random‐effects model, the pooled OR was 2.1363 (95% confidence interval, 1.5394‐2.9648), which corresponds to a risk of more than 10%. No significant changes to this risk were observed in the cumulative or stratified analyses. Although advances in surgical technique have been made, PXF syndrome continues to be a risk factor in phacoemulsification. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Adverse effects associated with collagenase clostridium histolyticum in Dupuytren disease: A prospective study

BACKGROUND Collagenase clostridium histolyticum is now recognized as a viable treatment for Dupuytren disease. The high rate of adverse effects reported in patients continues to spark debate and raise questions about the true frequency of effects and their associated mechanisms of action. HYPOTHESIS To investigate whether outcomes of CCH treatment are related to the number of adverse effects experienced. To evaluate short-term clinical outcomes in a series of patients. MATERIAL AND METHODS Prospective single-center cohort study. The Primary End Point for effectiveness at 30 days was deficit of 0°-5°. Adverse effects were evaluated during CCH injection, removal of the dressing prior to finger extension, and finger extension. To investigate the relationship between adverse effects and treatment effectiveness, we analyzed the association between number of effects and clinical outcome at 30 days. RESULTS A total of 208 injections were evaluated. The mean baseline contracture was 32.11°. Ninety-four patients (45.2%) had a mild contracture. Treatment was effective at 30 days in 194 of the injections (93.3%). The rate of effectiveness per joint was 93.5% for metacarpophalangeal joints (n=129) and 92.9% for proximal-interphalangeal joints (n=65). In total, 734 adverse effects were reported (mean, 3.53). No statistically significant associations were identified between disease severity and secondary effects. Variance analysis showed statistically significant differences in patients with severe contractures (mean, 3.91; 95% CI 3.57-4.25), and in patients with proximal-interphalangeal contractures (mean, 4.17; 95% CI 3.76-4.59). CONCLUSIONS We found no relationship between number of adverse effects and treatment effectiveness at one month following CCH injection. LEVEL OF PROOF IV, cohort prospective study.

Anesthesia for collagenase clostridium histolyticum injection in patients with dupuytren disease: A cohort analysis

Procedural pain is one of the most common adverse effects reported by patients with Dupuytren disease (DD) treated with collagenase clostridium histolyticum (CCH). The aim of this study was to assess the effectiveness of wrist block before CCH injection in reducing procedural pain and to analyze its impact on adverse effects. We performed a prospective, single-center study in which we compared two groups of patients in a consecutive cohort. In the first group (NO-BLOCK), wrist block was only performed before finger extension, whereas in the second group (BLOCK), it was performed before CCH injection and finger extension. Pain was assessed on a 10-item numerical rating scale. Our results show that pain scores were clearlylower in the BLOCK group than in the NO-BLOCK group: 4.72 vs. 0.61 for CCH injection and 3.43 vs. 0.82 for finger extension. Patients who rated CCH injection pain with a score of 4 or higher were 11 times more likely to experience pain during extension. There was a weak correlation between the use of wrist block for CCH injection and the occurrence of skin lacerations (Spearmans rho = -0.222, p < 0.01) and the presence of pruritus (Spearmans rho = 0.183, p < 0.07). In conclusion, wrist block before CCH injection is an effective measure of decreasing perceived pain throughout the different stages of CCH treatment in patients with DD.

An Easy Way for Clinical Validation of the Pharmacoeconomic Model in Dupuytren Disease

The traditional way in which clinical validation takes place in pharmacoeconomics has always been to gather expert clinical opinions on the disease so that models take into account all possible events, both favorable and unfavorable, including secondary effects. These methods vary in the extent to which panels of experts adopt strict, formal, and explicit standards for interacting and communicating in order to reach a consensus.

Proposed model to determine satisfaction with computerised provider order entry systems in a long-stay hospital

Objectives Computerised provider order entry (CPOE) systems reduce medication errors, but are not without dangers. Knowing satisfaction with the CPOE helps to improve its implementation. Our objective was to determine the satisfaction of healthcare professionals with the CPOE in a long-stay hospital and to propose a single model. Methods A cross-sectional study in a long-stay hospital. Two questionnaires were distributed to determine satisfaction with CPOE, one for medical personnel (MP) and another for nursing personnel (NP). Data collected were: sex, age and work aspects. A strategy for item refinement and creation of a single scale was designed. Results The overall participation rate was 63.6%, with 68 responses from the target population of 107. Overall, 72.2% (13 of 18) of MP and 40% (20 of 50) of NP were satisfied with CPOE. Regarding the specific questions on satisfaction in the questionnaires, 88.9% (n=16) of MP were very satisfied but only 56.0% (n=28) of NP. The median of each question was 4, with the exception of those for NP referring to a faster process and improved coordination, which were 3 and 3.5, respectively. The items weighing more in the second component were eliminated and the questions merged. After refining the items, a final six-item model was obtained with a single component of high reliability (Cronbach’s α=0.896), which accounts for 67% of total variance. Conclusion The degree of satisfaction with CPOE in a long-stay hospital was high, though lower in NP than MP. Obtaining a single questionnaire can facilitate this process.

Are Really Collagenase Clostriodium Hitolyticum Injections More Effective than Surgical Release

*Orthopedics and Traumatology Surgery, Head of Orthopedics and Traumatology Surgery, Hospital de Denia Marina Salud, Partida Beniadla, S/N, Denia, Alicante, Pharm D. Pharmacy Service, Hospital Dr Moliner, Porta Coeli s/n Serra, Valencia, Doctor of Pharmacy Program, University of Granada, Pharm D. Head of Pharmacy Service, Hospital de Denia Marina Salud, Partida Beniadla, S/N, Denia, Alicante, Ophtalmologic Department, Hospital Virxen da Xunqueira, Cee, A Coruna, Spain Letter to the Editor Hand Surgery 2015;20(2):333-334 • DOI: 10.1142/S0218810415200038