The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC)  

Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC  

Endorsed by the European Stroke Organisation (ESO)

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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS: The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC). Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Endorsed by the European Stroke Organisation (ESO)

Infectious Diseases Society of America.

A Panel of International Experts was convened by the Infectious Diseases Society of America (IDSA) in collaboration with the European Society for Microbiology and Infectious Diseases (ESCMID) to update the 1999 Uncomplicated Urinary Tract Infection Guidelines by the IDSA. Co-sponsoring organizations include the American Congress of Obstetricians and Gynecologists, American Urological Association, Association of Medical Microbiology and Infectious Diseases-Canada, and the Society for Academic Emergency Medicine. The focus of this work is treatment of women with acute uncomplicated cystitis and pyelonephritis, diagnoses limited in these guidelines to premenopausal, non-pregnant women with no known urological abnormalities or co-morbidities. The issues of in vitro resistance prevalence and the ecological adverse effects of antimicrobial therapy (collateral damage) were considered as important factors in making optimal treatment choices and thus are reflected in the rankings of recommendations.

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International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases

Objective: The aim was to formulate clinical practice guidelines for pheochromocytoma and paraganglioma (PPGL). Participants: The Task Force included a chair selected by the Endocrine Society Clinical Guidelines Subcommittee (CGS), seven experts in the field, and a methodologist. The authors received no corporate funding or remuneration. Evidence: This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence. The Task Force reviewed primary evidence and commissioned two additional systematic reviews. Consensus Process: One group meeting, several conference calls, and e-mail communications enabled consensus. Committees and members of the Endocrine Society, European Society of Endocrinology, and Americal Association for Clinical Chemistry reviewed drafts of the guidelines. Conclusions: The Task Force recommends that initial biochemical testing for PPGLs shou...

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Pheochromocytoma and paraganglioma: An endocrine society clinical practice guideline

The effect of chronic alcohol consumption on Na(+)-K+ ATPase, Na(+)-Li+ countertransport, outward Na(+)-K(+)-Cl- cotransport system and the Na+ leak was investigated in red blood cells from 18 normotensive subjects with a daily alcohol intake of more than 150 g The study was repeated after 3 months of alcohol withdrawal, and results were compared with a group of 20 healthy normotensive teetotalers Maximal efflux rate (Vmax) and apparent dissociation constant for internal Na+ (KNa) of the Na(+)-K+ pump and the Na(+)-Li+ countertransport were significantly higher in alcohol consumers A positive correlation between daily alcohol intake and Vmax of both transport systems (p less than 005) was observed These values significantly decreased after alcohol withdrawal A simultaneous stimulation of the Na(+)-K(+)-Cl- cotransport system after alcohol withdrawal was also observed Blood pressure values were higher in alcoholics (1337/823) than in abstainers (1214/75 mmHg) and significantly decreased (1285/769 mmHg) after withdrawal A positive correlation between the stimulation of the Na(+)-K(+)-Cl- cotransport and the decrease of blood pressure after withdrawal was observed In conclusion, chronic alcohol intake induces disturbances on red blood cell Na+ metabolism that dissipate with the cessation of drinking Similar abnormalities also reported in humans and animals with primary hypertension have been associated in the pathogenesis of essential hypertension Therefore, the pressor effect of chronic alcohol intake could be mediated through these changes in cellular Na+ metabolism

Chronic alcohol intake induces reversible disturbances on cellular Na+ metabolism in humans: its relationship with changes in blood pressure.

Introduction and objectives. To determine the prevalence and clinical characteristics of non-traumatic chest pain, to assess the quality of treatment provided by an emergency department chest pain unit (CPU), and to provide a theoretical estimate of the size of future CPUs. Methods. This prospective study included 1000 consecutive patients with chest pain seen at a CPU and a second group comprising the remaining patients seen for other complaints. Data on the patients’ clinical characteristics, final diagnosis, destination (ie, admitted or discharged), waiting time, and length of stay were recorded. In the CPU, the door-to-ECG time, and, when referred, the door to needle time and the door-to-balloon time were also recorded. In considering CPU size, the number of chest pain patients and the time to admission or discharge were utilized. Results. Among 22 468 visits, the prevalence of chest pain was 4.4%. Compared with other patients, those with chest pain were more frequently male, older, had to wait less time, and were admitted more often. Of the 1000 chest pain patients, 25.9% had acute coronary syndrome (ACS), 64.7% did not, and 9.4% were not diagnosed because exercise testing could not be performed. Patients with ACS were older and had more cardiovascular risk factors, but no gender difference was found. The door-to-ECG time was 10 min, the door to needle time was 26 min, and the door-to-balloon time was 51 min. One CPU stretcher is required for every 13 000 emergency department visits per year. Conclusions. The prevalence of chest pain and affected patients’ distinct clinical profile support the

Performance Assessment of an Emergency Department Chest Pain Unit

Resumen Objetivos Evaluar el conocimiento del documento de voluntades anticipadas (DVA) en pacientes con enfermedades cronicas que acuden a urgencias por descompensacion y en sus acompanantes. Conocer el posicionamiento del paciente a redactar el DVA e investigar factores asociados. Material y metodo Estudio descriptivo sobre pacientes con enfermedad cronica atendidos en urgencias de un hospital urbano universitario. Se consignaron variables clinicodemograficas y, tras el control de su sintomatologia, se efectuo una entrevista-encuesta oral y anonima. Como variables dependientes se consideraron el conocimiento previo del DVA y la predisposicion a confeccionarlo. Se analizo si existian variables asociadas a ellas. Resultados Se entrevistaron 380 personas. Los acompanantes, con respecto a los pacientes, eran mas frecuentemente mujeres (el 76 frente a el 42%; p Conclusiones Se constata un desconocimiento generalizado del DVA en pacientes con enfermedades cronicas y en sus acompanantes. No obstante, casi la mitad de los pacientes estarian dispuestos a su confeccion. Los servicios de urgencia hospitalarios pueden contribuir a mejorar la informacion.

Grado de conocimiento del documento de voluntades anticipadas por el enfermo crónico que acude a urgencias

Objective To apply lean thinking in triage acuity level-3 patients in order to improve emergency department (ED) throughtput and waiting time. Design A prospective interventional study. Setting An ED of a tertiary care hospital. Participants Triage acuity level-3 patients. Intervention(s) To apply lean techniques such as value stream mapping, workplace organization, reduction of wastes and standardization by the frontline staff. Main Outcome Measure(s) Two periods were compared: (i) pre-lean: April-September, 2015; and (ii) post-lean: April-September, 2016. Variables included: median process time (time from beginning of nurse preparation to the end of nurse finalization after doctor disposition) of both discharged and transferred to observation patients; median length of stay; median waiting time; left without being seen, 72-h revisit and mortality rates, and daily number of visits. There was no additional staff or bed after lean implementation. Results Despite an increment in the daily number of visits (+8.3%, P < 0.001), significant reductions in process time of discharged (182 vs 160 min, P < 0.001) and transferred to observation (186 vs 176 min, P < 0.001) patients, in length of stay (389 vs 329 min, P < 0.001), and in waiting time (71 vs 48 min, P < 0.001) were achieved after lean implementation. No significant differences were registered in left without being seen rate (5.23% vs 4.95%), 72-h revisit rate (3.41% vs 3.93%), and mortality rate (0.23% vs 0.15%). Conclusion Lean thinking is a methodology that can improve triage acuity level-3 patient flow in the ED, resulting in better throughput along with reduced waiting time.

Improvement of emergency department patient flow using lean thinking.

Fundamento y objetivo La utilizacion de los servicios de urgencias hospitalarios (SUH) es cadavez mayor, lo que conduce a su masificacion. El objetivo del presente trabajo es definir la «saturacion» de un SUH y determinar y cuantificar los factores que la condicionan. Pacientes y metodo Durante tres semanas consecutivas de anos distintos (2000-2002) se contabilizaroncada 3 h las entradas, el indice de ocupacion (IO) de los pacientes que permanecianen el SUH, en el area de primera asistencia (APA) y en el area de observacion (AO) segun lacausa de dicha permanencia. Los datos se sometieron a analisis de regresion logistica multiplecon la variable dependiente «saturacion/no saturacion» de cada una de las areas (SUH, APA yAO). Se definio la saturacion cuando el IO era igual o superior al 100%. Los modelos de cadaarea se calibraron por la prueba de Hosmer-Lemeshow y se discriminaron por metodologia ROC.Los modelos explicativos se armaron separando aleatoriamente dos grupos: seleccion (88% dedatos) y validacion (12% de datos). Resultados Las variables que se asociaron de forma significativa a la saturacion en el modelodel SUH fueron el IO debido a los pacientes que esperaban resultados, ir a una cama, encontrarcama, exploraciones complementarias y en evolucion. En el modelo del APA, lo fueron elIO debido a los que estaban visitandose y esperaban resultados. Finalmente, para el modelodel AO lo fueron el IO debido a los que esperaban ir a una cama, encontrar cama, exploracionescomplementarias y en evolucion. Todos los modelos mostraron sensibilidad y especificidadsuperiores al 85% y un area ROC superior a 0,97. En ningun caso el numero de pacientes queacuden a urgencias participo del modelo explicativo final. En el grupo de validacion se confirmaronestos resultados. Conclusiones Los pacientes que permanecen en el servicio de urgencias por factores dependientestanto del hospital (esperando ir a una cama o encontrar una cama) como del propio serviciode urgencias (esperando evolucion) son la principal causa de saturacion de los SUH.

Miquel Sánchez

Papers

Chronic alcohol intake induces reversible disturbances on cellular Na+ metabolism in humans: its relationship with changes in blood pressure.

Performance Assessment of an Emergency Department Chest Pain Unit

Grado de conocimiento del documento de voluntades anticipadas por el enfermo crónico que acude a urgencias

Improvement of emergency department patient flow using lean thinking.

Saturación del servicio de urgencias: factores asociados y cuantificación