¿Quién decide qué datos deben constar en la historia clínica en relación con el origen biológico?

There is an increasing request by patients or their representatives not to have some data registered in their clinical history or if such data exists to be deleted. Without doubt, this is so because such clinical data is accessed by various professionals who in most cases are not directly involved in caring for such patients. On the other hand, such data is copied and iteratively and unnecessary reproduced in various discharge reports and others forms. The problem arises when such controversial data refer to particularly sensitive clinical aspects such as assisted reproduction techniques, which invades personal and family privacy. Therefore, the question is who determines what data should be recorded in the medical records and according to what criteria should be taken that decision?     

Adaptation and validation of stroke-aphasia quality of life (SAQOL-39) scale to Malayalam

Background:

Aphasia, an acquired inability to understand and/or speak language, is a common repercussion of stroke that denigrates the quality of life (QOL) in the affected persons. Several languages in India experience the dearth of instruments to measure the QOL of persons with aphasia. Malayalam, the language spoken by more than 33 million people in Kerala, the southern state of India, is not an exception to this.

Objective:

This study aimed to adapt and validate the widely-used stroke-aphasia quality of life (SAQOL-39) scale to Malayalam.

Materials and Methods:

We required seven Malayalam-speaking Speech Language Pathologists (SLPs), hailing from different regions of Kerala, to examine the socio-cultural suitability of the original items in SAQOL-39 and indicate modifications, wherever necessary. Subsequently, the linguistic adaptation was performed through a forward-backward translation scheme. The socio-culturally and linguistically adapted Malayalam version was then administered on a group of 48 Malayalam-speaking persons with aphasia to examine the test-retest reliability, acceptability, as well as the internal consistency of the instrument.

Results:

The Malayalam SAQOL-39 scale showed high test-retest reliability (intraclass correlation coefficient, ICC = 0.91) as well as acceptability with minimal missing data (0.52%). Further, it yielded high internal consistency (Chronbach''s ∝ = 0.98) as well as item-to-total and inter-domain correlations.

Conclusions:

The Malayalam version of SAQOL-39 is the first socio-culturally and linguistically adapted tool to measure the QOL of persons with stroke-aphasia speaking this language. It may serve as a potential tool to measure the QOL of this population in both clinical practice and future research endeavors.     

Pharmacodynamic Effects of Pre-Hospital Administered Crushed Prasugrel in Patients With ST-Segment Elevation Myocardial Infarction

ObjectivesThis study sought to compare the pharmacodynamic effects of pre-hospitally administered P2Y₁₂ inhibitor prasugrel in crushed versus integral tablet formulation in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI).BackgroundEarly dual antiplatelet therapy is recommended in STEMI patients. Yet, onset of oral P2Y₁₂ inhibitor effect is delayed and varies according to formulation administered.MethodsThe COMPARE CRUSH (Comparison of Pre-hospital Crushed Versus Uncrushed Prasugrel Tablets in Patients With STEMI Undergoing Primary Percutaneous Coronary Interventions) trial randomized patients with suspected STEMI to crushed or integral prasugrel 60-mg loading dose in the ambulance. Pharmacodynamic measurements were performed at 4 time points: before antiplatelet treatment, at the beginning and end of pPCI, and 4 h after study treatment onset. The primary endpoint was high platelet reactivity at the end of pPCI. The secondary endpoint was impact of platelet reactivity status on markers of coronary reperfusion.ResultsA total of 441 patients were included. In patients with crushed prasugrel, the occurrence of high platelet reactivity at the end of pPCI was reduced by almost one-half (crushed 34.7% vs. uncrushed 61.6%; odds ratio [OR] = 0.33; 95% confidence interval [CI] = 0.22 to 0.50; p < 0.01). Platelet reactivity <150 P2Y₁₂ reactivity units at the beginning of coronary angiography correlated with improved Thrombolysis In Myocardial Infarction flow grade 3 in the infarct artery pre-pPCI (OR: 1.78; 95% CI: 1.08 to 2.94; p = 0.02) but not ST-segment resolution (OR: 0.80; 95% CI: 0.48 to 1.34; p = 0.40).ConclusionsOral administration of crushed compared with integral prasugrel significantly improves platelet inhibition during the acute phase in STEMI patients undergoing pPCI. However, a considerable number of patients still exhibit inadequate platelet inhibition at the end of pPCI, suggesting the need for alternative agents to bridge the gap in platelet inhibition.     

Antiangiogenesis is produced by nontoxic doses of vinblastine

The effects of vinblastine (VBL) on endothelial cell functions involved in angiogenesis, namely proliferation, chemotaxis, spreading on fibronectin (FN), secretion of matrix-metalloproteinase-2 (MMP-2) and MMP-9, and morphogenesis on Matrigel were tested in vitro, whereas its effects on angiogenesis were studied in vivo by using the chick embryo chorioallantoic membrane (CAM) model. In vitro, at noncytotoxic doses (0.1, 0.25, 0. 5, 0.75, and 1 pmol/L), VBL impacted all these functions, except secretion of MMPs, in a dose-dependent fashion. By contrast, proliferation of other primary cells such as fibroblasts and lymphoid tumor cells was not impacted. In vivo, VBL at 0.5, 0.75, and 1 pmol/L again displayed a dose-dependent antiangiogenic activity. Lack of cytotoxicity in vitro and in vivo was shown both morphologically, and also because the antiangiogenic effects were rapidly abolished when VBL was removed. Apoptosis was not induced. At the ultrastructural level, impairment of cell functions in vitro was associated with thin disturbance of the cytoskeleton, in the form of slight depolymerization and accumulation of microfilaments, which was equally reversible. Results suggest that VBL has an antiangiogenic component at very low, noncytotoxic doses, and that antiangiogenesis by VBL could be used to treat a wide spectrum of angiogenesis-dependent diseases, including certain chronic inflammatory diseases, Kaposi's sarcoma, and cancer.     

Recommendations From a National Panel on Quality Improvement in Obstetrics

This paper describes the recommendations of a national panel on quality improvement in obstetrics to identify priorities for action among five areas of greatest medico-legal risk. Using previously conducted medico-legal data analyses and a systematic literature review, the panel reviewed existing data and developed recommendations for areas of focus in quality improvement in five obstetrical high-risk areas. The panel recommended clarification of definitions in some areas, identified needs for data collection and standardization of practices in others. The most promising interventions to improve care in the five areas were grouped into: standardized processes (such as protocols and communication tools), checklists, audit and feedback, mentoring and coaching, inter-professional communication, simulation and training, and shared decision making guides. This national panel of experts created 18 action-oriented recommendations focused on quality improvement to reduce medico-legal risk and improve the safety of care for Canadian mothers and babies.     

Progress and shortcomings in European national strategic plans for pandemic influenza

Objective

To repeat and update our previous evaluation (2005) of Europe’s national pandemic influenza preparedness plans and assess the progress that has been made.

Methods

We assessed published national pandemic influenza preparedness plans from the European Union countries, from the two acceding countries (Bulgaria and Romania) and from Norway, Switzerland and Turkey. Plans were eligible for inclusion if formally published before 30 September 2006. We referred to WHO guidelines and used a systematically applied data extraction form. We considered plans in relation to border control measures, antiviral drugs and vaccines.

Findings

Twenty-nine countries had plans that were included in the analysis, compared with 21 countries in 2005. Substantial differences existed in countries’ plans for border control measures, and many plans diverged from WHO guidelines. Likewise, countries’ plans on antiviral drugs and vaccines varied and operational planning remained weak.

Conclusion

Although progress has been made in the completeness of plans, problems remain unsolved regarding national plans’ divergence from international recommendations, persisting strategic incoherence and operational limitations in relation to potentially scarce resources. Border control plans also show gaps and inconsistencies, and these are likely to be politically volatile during a pandemic.     

South African cause-of-death profile in transition--1996 and future trends.

This paper describes the South African cause-of-death profile in 1996, the latest year for which routine data are available. Underreporting of deaths, misclassification of causes and HIV/AIDS make face value interpretation of reported cause-of-death data difficult. Changes in subsequent years due to HIV/AIDS are considered using model projections. South Africa is undergoing a protracted bipolar transition with the coexistence of both diseases of poverty and emerging chronic diseases. In 1996 these accounted for similar proportions of the premature mortality, about 27% for males and 35% for females, with the added burden of injuries accounting for a further 35% in males and 16% in females. Tuberculosis (TB), lower respiratory tract infections, diarrhoea, HIV/AIDS, perinatal diseases, malnutrition and septicaemia contributed to the pretransitional conditions, while stroke, diabetes, ischaemic heart disease, hypertensive heart disease, asthma, chronic obstructive lung disease, cancer of the lung in men and cancer of the cervix in women contributed to the premature mortality due to non-communicable diseases. Homicide is the major cause of injury death for men while unintentional injuries are the major cause of injury death for women. Projections suggest that this triple burden (diseases of poverty, emerging chronic diseases and injuries) has now become a quadruple burden resulting from the HIV/AIDS epidemic and that without interventions to reduce mortality, by the year 2010, AIDS deaths will account for double all other causes of death combined. While efforts to improve the cause-of-death statistics are needed, the current data clearly suggest that comprehensive public health strategies to improve the health of the nation must be strengthened, and reducing the number of deaths that can be expected to result from AIDS requires urgent attention.