Roser Font

Medidas de restricción física en un hospital de agudos y en dos centros de media y larga estancia: estudio de prevalencia y análisis de aspectos éticos relacionados con su indicación y puesta en práctica

Resumen Fundamento Se realiza un estudio de prevalencia de pacientes sometidos a restriccion fisica (RF) durante su ingreso hospitalario en centros de agudos y de larga estancia. Los objetivos son cuantificar esta practica y estudiar sus caracteristicas, asi como promover la elaboracion de una guia de actuacion para un correcto uso de la RF. Pacientes y metodo Se han llevado a cabo dos cortes transversales mediante entrevistas al personal responsable de los enfermos hospitalizados y la revision de las historias clinicas de todos los pacientes con RF en un hospital de agudos (Hospital Mutua de Terrassa [HMT]), en un centro de convalecencia y media estancia (Centre sociosanitari Vallparadis) y en un centro de larga estancia (Centre Residencial l’Ametlla del Valles), todos pertenecientes al Grup Mutua de Terrassa. Este trabajo se ha promovido desde el Comite de Etica Asistencial del HMT. Resultados La prevalencia de enfermos con RF oscila entre el 1,5 y el 27,8%, dependiendo del corte y del centro. En el centro de agudos, el motivo mas frecuente para aplicar sujecion a los pacientes es evitar que se retiren sueros o sondas (27,3%), mientras que en los otros centros es el de evitar caidas (33,3%). El material utilizado no siempre esta homologado (el 31% en el HMT y en mas del 80% en el centro de larga estancia). El grado de implicacion del medico en esta decision es bajo y raramente queda reflejado por escrito (inferior al 5% en el centro de enfermos agudos). Se utilizan pocas alternativas al uso de restriccion fisica. Conclusiones Se ha constatado que es aconsejable elaborar una guia de actuacion que contemple cuando, como y quien ha de tomar la decision de aplicar restriccion fisica a los pacientes. No es en absoluto habitual que conste el hecho de la RF en ningun documento de la historia clinica a excepcion de los registros de enfermeria; asimismo, no siempre se utiliza el material homologado. No se contemplan alternativas a la RF en la mayoria de situaciones. El estamento medico no se siente muy implicado en el tema de la RF.

HIV-Infection, Atherosclerosis and the Inflammatory Pathway: Candidate Gene Study in a Spanish HIV- Infected Population

Background Higher prevalence of atherosclerosis and higher cardiovascular risk is observed in HIV-infected individuals. The biological mechanisms underlying these processes are unclear. Several studies have implicated genetic variants in the inflammatory genes in cardiovascular disease and in HIV natural course infection. Methods & Findings In this study we have tested the possible association between genetic variants in several inflammatory genes and asymptomatic cardiovascular disease measured by carotid intima media thickness (cIMT) and atherosclerotic plaque presence as dependent variables in 213 HIV-infected individuals. A total of 101 genetic variants in 25 candidate genes have been genotyped. Results were analyzed using Plink and SPSS statistical packages. We have found several polymorphisms in the genes ALOX5 (rs2115819 p = 0.009), ALOX5AP (rs9578196 p = 0.007; rs4769873 p = 0.004 and rs9315051 p = 0.0004), CX3CL1 (rs4151117 p = 0.040 and rs614230 p = 0.015) and CCL5 (rs3817655 p = 0.018 and rs2107538 p = 0.018) associated with atherosclerotic plaque. cIMT mean has been associated with CRP (1130864 p = 0.0003 and rs1800947 p = 0.008), IL1RN (rs380092 p = 0.002) and ALOX5AP (rs3885907 p = 0.02) genetic variants. Conclusions In this study we have found modest associations between genetic variants in several inflammatory genes and atherosclerotic plaque or cIMT. Nevertheless, our study adds evidence to the association between inflammatory pathway genetic variants and the atherosclerotic disease in HIV-infected individuals.

Estudio comparativo de concordancia y costes entre la prueba de la tuberculina y QuantiFERON ®-TB Gold In-Tube en el diagnóstico de la infección latente tuberculosa en contactos de pacientes con tuberculosis pulmonar

INTRODUCTION Recently diagnosis of latent tuberculosis infection (LTBI) can be made using the tuberculin skin test (TST) or by techniques known as interferon-γ release assays (IGRAS), being QuantiFERON(®)-TB Gold In-Tube (QF-G-IT) the most used. The IGRAS avoid some drawbacks of the TST, especially cross-reaction with bacillus Calmette-Guérin (BCG) vaccine, but also present some problems such as those arising from cost and the need of having an adequate infrastructure and experience. There is no clear consensus on which technique should be preferentially used for the diagnosis of LTBI. METHODS This is a comparative study between the TST and QT-G-IT in a cohort of contacts of patients with pulmonary tuberculosis during the study period. An analysis of global agreement and groups was performed according to whether the contacts were vaccinated with BCG or not. A study of costs of both techniques and diagnostic strategies based on these techniques was performed. RESULTS The agreement between TST and QF-G-IT was acceptable in the whole sample yet it was very good in the unvaccinated group. Few cases of indeterminate values were recorded. The cost study showed that TST was cheaper than QF-G-IT; however when we analyzed the cost of the strategies according to each technique, the QF-G-IT showed a better cost-benefit. CONCLUSION We suggest considering QF-G-IT as the only preferred technique for the diagnosis of LTBI in household contacts, based on good overall agreement between the 2 techniques (even if we eliminate the effect of the vaccine) and a cost analysis favorable to QF-G-IT.

Comités éticos: perfil de los miembros no sanitarios de los comités éticos de investigación clínica y comités de ética asistencial de Cataluña

Noemı́ Villén , Susana Redondo , Roser Font b y Salvador Quintana * a Comité Ético de Investigación Clı́nica, Hospital Universitari Mútua de Terrassa, Fundació per la Recerca i la Docència, Universitat de Barcelona, Terrassa, Barcelona, España b Comité de Ética Asistencial, Hospital Universitari Mútua de Terrassa, Fundació per la Recerca i la Docència, Universitat de Barcelona, Terrassa, Barcelona, España