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Vascular access continues to be a key factor for the reliable and safe delivery of intravenous (IV) therapy to patients in any healthcare setting. Clinical guidelines advocate for the right vascular access device selection, in order to reduce avoidable complications, eg multiple stabs, phlebitis, thrombophlebitis, insertion site infection, and blood stream infection, while improving efficiency and reducing costs. Peripheral intravenous catheters or cannulas (PIVCs) remain widely used for gaining vascular access in all clinical settings, with both adults and children, because they provide a relatively cheap and simple way to provide blood sampling and the prompt administration of IV medications. Although safe and easy to insert, PIVCs present with associated risks that can be costly to the organisation. The case studies included with this article introduce Nipro's Safetouch Cath Winged with Injection Port as a new cost-effective choice of PIVC, which is now available from NHS Supply Chain.

El dolor lumbar (DL) en las mujeres embarazadas puede causar un impacto negativo para realizar las actividades cotidianas, reducir la calidad de vida y aumentar el absentismo laboral. A pesar de su alta prevalencia, que varía del 13,2 al 80%, se estima que más del 50% de las mujeres embarazadas reciben poca o ninguna intervención de los profesionales sanitarios y, con frecuencia, se considera erróneamente como un fenómeno normal.

The establishment of advanced nurse practitioners (ANPs) has expanded considerably in recent years and shown to result in substantial contributions to numerous fields of health care. Due to advancements in treatments and innovations in medicine, patients with cancer are living longer, requiring a multifactorial holistic approach in which ANPs, due to their skills and knowledge, can be best utilised, as they are able to provide the expert care required at various stages of the patient journey. This article explores scopes of practice from ANPs working with oncology patients in a tertiary cancer centre, making explicit their roles, in addition to highlighting experienced challenges and future directions of care.

High‐quality data on bone marrow involvement (BMI) assessed by flow cytometry (FC) in follicular lymphoma (FL) is lacking. We set up a prospective protocol with a 10‐color tube and acquisition of 500.000 leukocytes on a Nav flow cytometer for evaluation of BMI in FL by FC. FC was compared with a combination of histopathology and IGHgene rearrangement, which were considered the gold standard. We also compared BMI by FC with PET. Fifty‐two patients were included (median 67 years, 54% female). BMI by FC was seen in 35 (67%), with a median involvement of 1.2% (interquartile range: 0.3%–7%) of leukocytes. Comparison with the gold standard revealed two false negatives and two false positives (potentially true involvement undetected by the gold standard). BMI by PET was seen in 14/46 (30%). Immunophenotype of FL in the bone marrow was highly heterogeneous. The most common phenotypic abnormality was dim expression of CD19 (>0.5 log loss in 30% of patients). CD10 was negative in 13 (37%) and incompletely positive (overlap with the negative population) in a further 8 (28%) while entirely positive only in 14 (48%). Other abnormalities (loss of CD20, gain or loss of CD79b, expression of CD43, and substantial loss of CD45) were rare. Computational analysis by means of FlowSOM confirmed the heterogeneous phenotype, with FL from different patients clustering in unrelated metaclusters. BMI by FL was frequent and immunophenotype was heterogeneous. However, this protocol enabled detection of FL in bone marrow in the vast majority of patients with bone marrow involvement by the gold standard.

The 2017 European LeukemiaNet (ELN 2017) guidelines for the diagnosis and management of acute myeloid leukemia (AML) have become fundamental guidelines to assess the prognosis and postremission therapy of patients. However, they have been retrospectively validated in few studies with patients included in different treatment protocols. We analyzed 861 patients included in the Cooperativo Para el Estudio y Tratamiento de las Leucemias Agudas y Mielodisplasias-12 risk-adapted protocol, which indicates cytarabine-based consolidation for patients allocated to the ELN 2017 favorable-risk group, whereas it recommends allogeneic stem cell transplantation (alloSCT) as a postremission strategy for the ELN 2017 intermediate- and adverse-risk groups. We retrospectively classified patients according to the ELN 2017, with 327 (48%), 109 (16%), and 245 (36%) patients allocated to the favorable-, intermediate-, and adverse-risk group, respectively. The 2- and 5-year overall survival (OS) rates were 77% and 70% for favorable-risk patients, 52% and 46% for intermediate-risk patients, and 33% and 23% for adverse-risk patients, respectively. Furthermore, we identified a subgroup of patients within the adverse group (inv(3)/t(3;3), complex karyotype, and/or TP53 mutation/17p abnormality) with a particularly poor outcome, with a 2-year OS of 15%. Our study validates the ELN 2017 risk stratification in a large cohort of patients treated with an ELN-2017 risk-adapted protocol based on alloSCT after remission for nonfavorable ELN subgroups and identifies a genetic subset with a very poor outcome that warrants investigation of novel strategies.

The 2017 European LeukemiaNet (ELN 2017) guidelines for the diagnosis and management of acute myeloid leukemia (AML) have become fundamental guidelines to assess the prognosis and postremission therapy of patients. However, they have been retrospectively validated in few studies with patients included in different treatment protocols. We analyzed 861 patients included in the Cooperativo Para el Estudio y Tratamiento de las Leucemias Agudas y Mielodisplasias-12 risk-adapted protocol, which indicates cytarabine-based consolidation for patients allocated to the ELN 2017 favorable-risk group, whereas it recommends allogeneic stem cell transplantation (alloSCT) as a postremission strategy for the ELN 2017 intermediate- and adverse-risk groups. We retrospectively classified patients according to the ELN 2017, with 327 (48%), 109 (16%), and 245 (36%) patients allocated to the favorable-, intermediate-, and adverse-risk group, respectively. The 2- and 5-year overall survival (OS) rates were 77% and 70% for favorable-risk patients, 52% and 46% for intermediate-risk patients, and 33% and 23% for adverse-risk patients, respectively. Furthermore, we identified a subgroup of patients within the adverse group (inv(3)/t(3;3), complex karyotype, and/or TP53mutation/17p abnormality) with a particularly poor outcome, with a 2-year OS of 15%. Our study validates the ELN 2017 risk stratification in a large cohort of patients treated with an ELN-2017 risk-adapted protocol based on alloSCT after remission for nonfavorable ELN subgroups and identifies a genetic subset with a very poor outcome that warrants investigation of novel strategies.

Most patients in hospital will have some form of intravenous (IV) catheter in situ at some time to facilitate the administration of IV therapy. Accidental dislodgement, although widespread, is often unrecognised as a contributor to IV catheter failure. Dislodgement usually contributes to the delay in the administration of treatment, time-consuming IV restarts and a potential need for more invasive procedures. Dislodgement has serious implications, with costs to both patient and healthcare costs. Historically, prevention of IV catheter dislodgement has focused on the use of the correct securement methods and technique; however, these fail in many occasions, for example, where patients are confused or during bed transfers. In the recent years, new breakaway connector systems, such as ReLink, have been designed, which allow the tubing to become disconnected when undue pressure or pull is placed on it. This is done by a safety release valve that breaks apart, sealing off both ends of the tubing in an aseptic manner, while shutting off medication flow and preserving IV catheter integrity. Awareness raising and education focusing on accidental IV catheter dislodgement and the different ways to reduce its incidence in clinical practice would improve patient safety and potentially have significant healthcare savings.

ABSTRACTBackgroundVascular access by means of intravenous catheters is essential for the safe, effective and cost-efficient delivery of intravenous fluids, antibiotics, nutrition and chemotherapy, but the use of these devices is not without complications.PurposeA faculty of multidisciplinary European vascular access team (VAT) Leads/Members and experts sought to reframe how the implementation of a VAT could have positive impacts on patients and hospitals.MethodsInterview data from a Faculty of nine VAT Leads/Members and experts from six European countries on the impact of multidisciplinary VATs in modern healthcare were assessed. A literature search was conducted that included Medline®-cited peer-reviewed articles published in the past 10 years in order to identify impact data and post-implementation of a multidisciplinary VAT that support the benefits to patient safety and satisfaction and to hospital efficiencies reported in the interview program.ResultsWhile VATs vary in structure and function, clarity of purpose and supportive training and education are key. Barriers to the implementation of VATs show commonality across countries, such as lack of investment, insufficient training and lack of awareness. Proven markers of VAT success include rapid referrals, improved patient outcomes and improved organizational efficiency. Standardization of outcomes data capture, processing and reporting are key to monitoring performance against baseline. Awareness of the cost of complications arising from inappropriate choice and placement, and poor care and maintenance, of the vascular access device must be raised.ConclusionsThe implementation of VATs can positively impact patient safety and satisfaction, improve organizational efficiencies and cost-effectiveness, and could create new opportunities for in- and outpatient services, beneficial to both patients and institutions.

Las alteraciones del metabolismo óseo y mineral son muy frecuentes en la enfermedad renal crónica (ERC). El aumento en los niveles de fósforo condiciona enfermedad ósea, riego de calcificación y mayor mortalidad, por lo que cualquier estrategia encaminada a su reducción debe ser bienvenida. El último fármaco incorporado al arsenal terapéutico para tratar la hiperfosforemia en la ERC es el oxihidróxido sucroférrico (OSF).

Actualmente no existe un modelo establecido en la práctica clínica que permita predecir de forma fiable este parámetro. El objetivo del estudio fue valorar si existe correlación entre el área total sumada de los tendones recto interno (TRI) y semitendinoso (ST) en estudios preoperatorios de resonancia magnética (RM) y el diámetro intraoperatorio de la plastia.

Se estima que un 3% del total de parejas en edad reproductiva serán estériles debido a un factor masculino severo. En estos casos, se ha sugerido la existencia de un daño en el ADN espermático debido al efecto deletéreo que ejerce el estrés oxidativo sobre los espermatozoides a su paso por el tracto genital postesticular masculino. Esto ha llevado a proponer el uso generalizado de espermatozoides procedentes de biopsia testicular a pesar del riesgo quirúrgico que ello supone.

AbstractSpanish agri-food producers, particularly organic producers, have faced commercial problems for years. Websites are able to combine informative, relational and transactional functions. This ability makes them attractive sales channels in sectors such as the organic agri-food sector, which has traditionally had major commercial shortcomings in these three areas. This study is built on this premise. The study explored whether organic agri-food producers and conventional producers differ in terms of their use of websites as a sales channel and their degree of interaction with users. The extended model of Internet commerce adoption (eMICA) and fuzzy-set qualitative comparative analysis (fsQCA) were used. Other statistical techniques were also used. The fieldwork began with a sample of 998 producers (239 organic and 759 conventional). The results reveal differences between organic and conventional olive oil producers regarding website adoption and use. In terms of attracting website visits, the results also reveal the relevance of being an organic producer and having a capitalist or cooperative company structure.

This study describes the results of an assessment of the accuracy of relative measures between two points, and more specifically of speed values, obtained from Global Positioning Satellite Systems (GNSS) tracks acquired by contributors of Volunteered Geographic Information (VGI). The VGI does not usually include information about the positional accuracy of the trackpoints neither of speed values derived from these positions. Consequently, the assessment is based on a field test that consisted of a vehicle which travelled a highway with a set of Global Positioning System (GPS) devices like those commonly used by VGI contributors. These devices captured positions of trackpoints with a time interval of 1 second. Additionally, a more accurate geodetic RTK–GNSS receptor controlled these positions. The paper describes the methodology employed, taking into account several parameters such as the acquisition time interval, the accuracy of control positions, etc. The results have demonstrated the viability of the methodology applied, the possible use of VGI in order to determine the speed values of the trackpoints and the possible improvement in the accuracy achieved with the increase of the distance between trackpoints (and as a consequence of time interval), but with the disadvantage of a reduction in the quantity of trackpoints. Thus, several values of time intervals have been suggested, considering the accuracy required.

The following case studies describe the use of the Smith Medical implanted ports and Gripper huber needles. Smiths Medical produces a range of implanted ports that include the Port-A-Cath and P.A.S. Port Power P.A.C. systems. The ports are easy to implant, maintain and remove. They are lightweight and have features that are designed to reduce complication rates, including a highly compressed septum to increase needle retention, a titanium chamber with a gouge-resistant floor, a bevelled chamber for optimal rinsing, a round shape to avoid overturning and the Ultralock connection. They are available in various configurations, with single and dual lumens. There is also a needle for power-injection of contrast media for certain types of diagnostic imaging scans (Smith Medical 18).The Gripper Plus needle is designed with an emphasis on safety, effectiveness and patient comfort. These non-coring needles have a bevelled tip that sits flush with the back of the port without impeding the flow of fluid; this also prevents holes forming in the septum (Barton et al, 2018). The needle is available in different gauges and lengths, which can be tailored to reflect individual patient needs and the amount of adipose tissue present. It is essential to select the correct size, which will reduce the risk of dislodgement.The Gripper needles are compatible with paclitaxel and lipid solutions, and are recommended by the National Institute for Occupational Safety and Health (NIOSH) (1999). They are compatible with both the Port-a-Cath and P.A.S. Port Power P.A.C. systems, and can be ordered from the same manufacturer, which has the potential to make ordering, training and support more efficient.

En mujeres con una respuesta pobre a la estimulación de la ovulación (1-3 ovocitos) o subóptima (4-9 ovocitos), no es infrecuente obtener ovocitos inmaduros. Cuando este porcentaje es superior al 50% se le denomina asincronía folicular. Nuestro objetivo fue analizar, en mujeres de edad materna avanzada y una respuesta subóptima a la estimulación ovárica, la influencia de presentar asincronía folicular en los resultados del ciclo de ICSI.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and aggressive hematodermic neoplasm usually involving the skin. In this retrospective case series, 10 cases of BPDCN were identified, 90% of which had skin involvement and exhibited predominantly violaceous nodules and/or bruise-like plaques. Skin lesions showed diffuse or nodular dermal-based infiltrates of intermediate sized blasts with a grenz zone. Tumor immunophenotyping was CD4(+), CD56(+), CD123(+) and CD303(+). The most frequently mutated genes according to targeted next-generation sequencing were TET2 (3/7) and NRAS (2/7). Multiagent chemotherapy (CT) was administered as first-line therapy, and a total of 5 patients underwent allogenic hematopoietic stem cell transplantation (allo-HSCT). Better outcomes were observed in younger patients and those treated with acute lymphoblastic leukemia (ALL)-like CT followed by allo-HSCT. This study shows the clinical range of cutaneous lesions of BPDCN. Despite the absence of a gold standard therapy, patients treated with myeloablative intensive regimens and allo-HSCT seem to have a more favorable prognosis.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and aggressive hematodermic neoplasm usually involving the skin. In this retrospective case series, 10 cases of BPDCN were identified, 90% of which had skin involvement and exhibited predominantly violaceous nodules and/or bruise-like plaques. Skin lesions showed diffuse or nodular dermal-based infiltrates of intermediate sized blasts with a grenz zone. Tumor immunophenotyping was CD4(+), CD56(+), CD123(+) and CD303(+). The most frequently mutated genes according to targeted next-generation sequencing were TET2 (3/7) and NRAS (2/7). Multiagent chemotherapy (CT) was administered as first-line therapy, and a total of 5 patients underwent allogenic hematopoietic stem cell transplantation (allo-HSCT). Better outcomes were observed in younger patients and those treated with acute lymphoblastic leukemia (ALL)-like CT followed by allo-HSCT. This study shows the clinical range of cutaneous lesions of BPDCN. Despite the absence of a gold standard therapy, patients treated with myeloablative intensive regimens and allo-HSCT seem to have a more favorable prognosis.

Wind turbines (WT) components have established recycling routes. However, wind turbines blades (WTBs) composite materials present unique challenges for recycling. This study aims to develop a comprehensive decommissioning inventory of wind turbines installed in Europe up to the year 2022, with a focus on accounting for the end-of-life (EoL) mass of WTBs composite materials. The inventory provides an estimate of the total amount of WTB composite material that will need to be decommissioned in the coming decades, in terms of mass, mass rates, and volume. This estimate is further broken down by country, predicted decommissioning year, and blade architecture technology. To construct the inventory, data were collected on the total number of wind farms in operation, as well as those that are planned or under construction phase until the year 2022. The resulting inventory projects that over 7.6 million tons of EoL WTBs composite mass will need to be decommissioned in Europe by the year 2050.

AbstractOrganic agri-food products in Spain face major commercial problems in the home market as a result of consumers’ lack of information about this type of product and difficulties in accessing it, and the considerable price differential between organic products and their conventional equivalents. This study proposes that consideration should be given to social media as a factor for mitigating these commercial problems and improving the competitiveness of organic food companies. Specifically, the aim of this research was to examine the social media penetration and activity of olive oil sector companies and ascertain whether organic and non-organic operators present differences in this respect. To this end, a checklist was used to analyse the social media activity of 663 olive oil companies in total, comprising both organic and non-organic producers. The results reveal statistically significant differences in social media penetration and use by organic and non-organic operators, with the former being more active in these networks. Nevertheless, the social media efforts of organic operators are less effective, owing to the limited demand for their products.

Aproximadamente el 50% de las parejas estériles necesitará de técnicas de reproducción asistida para obtener una gestación, las cuales requieren de estimulación ovárica. Esta afecta a la calidad ovocitaria y embrionaria por el desarrollo de folículos de diferentes tamaños y estadios funcionales, que llevan a patrones hormonales diferentes al ciclo folicular natural. Muchos investigadores han adoptado el término luteinización precoz en ciclos de estimulación ovárica para los pacientes con elevación de progesterona (P) en el día del desencadenamiento de la ovulación. Sin embargo, el efecto fisiopatológico de esta elevación es controvertido. En este trabajo hemos querido profundizar en la fisiopatología de la luteinización precoz, analizando su influencia sobre la calidad ovocitaria.

Background:The prognosis of CLL patients that do not respond to targeted therapy is unfavourable, especially in the case of adverse genomic aberrations (e.g. TP53 alterations or complex karyotype) or after transformation to aggressive B lymphoma (Richter transformation, RT). In patients with refractory CLL, anti-CD19 CAR-T (CART19) therapy has achieved complete response (CR) rates of 19-45%, with RT usually excluded from pivotal trials. However, long-term remission in CLL patients still remains a challenge with CART19 therapy.

Background:Prognosis of relapsed/refractory (R/R) B-cell acute lymphoblastic leukemia (ALL) is poor, particularly after allogeneic hematopoietic cell transplantation (alloHCT). In this setting, several CAR T-cell products targeting CD19 (CART19) have been able to achieve complete response (CR) rates of 70 to 90%. However, a significant proportion of these patients still relapse. Several studies focus on the effect of the CART19 product on efficacy, however, information on how salvage therapy (ST) and bridging therapy (BT) can modulate the outcomes of CART19 therapy is scarce.

Le sclérœdème de Buschke (SB) est un syndrome sclérodermiforme (SS) rare appartenant au groupe des mucinoses cutanées, parfois associé à une gammapathie monoclonale (GM). Les caractéristiques cliniques, le pronostic et la thérapeutique de ces formes sont très peu décrites.

To analyze the effect of learning in two surgeons on complications and conversion to laparotomy during total and subtotal laparoscopic hysterectomy.

En los procesos del laboratorio clínico el mayor número de errores se da en las fases extratécnicas (pre- y postécnica). El análisis modal de fallos y efectos (AMFE) es un método para la gestión de fallos potenciales, identificar sus efectos y proponer medidas para disminuirlos. En este trabajo se realiza un AMFE de la fase pretécnica del laboratorio de reproducción asistida.

This paper describes a new method of data mining for determining a 3D mean axis from a set of surveyed Global Navigation Satellite Systems traces. The purpose is to obtain a mean axis and its uncertainty in order for them to be used in line-based positional controls. The method is based on an iterative process of condensation. The final mean axis is selected when a determined level of accuracy is achieved. So the method provides a relative positional accuracy value of the final solution. The example developed in this study demonstrates the viability of this method and allows analysis of the initial size of the set needed in order to achieve a final accuracy. Using real data, the proposed methodology has also been compared with the K-means methodology in order to analyse its advantages and conditions of use. The results have demonstrated an improvement in accuracy and geometrical definition of the axis obtained.

La endometriosis es una enfermedad caracterizada por la presencia de células endometriales fuera de la cavidad uterina y que provoca efectos negativos sobre la fecundidad de la mujer. Sin embargo, el mecanismo por el cual los produce continúa sin conocerse correctamente.

B-cell lymphoma 2 (BCL2)-type proteins are key regulators of the intrinsic or mitochondrial pathway for apoptosis. Since escape from apoptosis is one the main ‘hallmarks of cancer’, BCL2 inhibitors have emerged as promising therapeutic agents for diverse lymphoid malignancies, particularly chronic lymphocytic leukemia (CLL). Multiple clinical trials have shown efficacy of these agents in patients with relapsed/refractory disease with a favorable toxicity profile. Moreover, some clinical trials indicate that combination with monoclonal antibodies and other novel agents may enhance their effect.

La leucemia linfocítica crónica (LLC) es una proliferación de linfocitos B maduros que constituye una de las neoplasias hematológicas más prevalentes. Su tratamiento ha evolucionado en las últimas décadas hasta considerarse la inmunoquimioterapia a base de fludarabina, ciclofosfamida y rituximab el tratamiento de elección en pacientes de riesgo estándar y con buena situación funcional. Sin embargo, la caracterización de subgrupos biológicos de alto riesgo y la presentación de esta enfermedad en pacientes de edad avanzada y/o con comorbilidad ha llevado en los últimos años al desarrollo y aprobación de tratamientos dirigidos, especialmente los inhibidores del receptor del linfocito B. La presente revisión repasa las estrategias terapéuticas convencionales y se centra en las nuevas moléculas que ya constituyen elementos prometedores del actual panorama terapéutico de la LLC.

Traditionally, the uncertainty models for segments and lines and positional accuracy assessment methods based on lines have worked with 2D elements. But the increasing availability of 3D data leads us to conjecture the need to adapt existing models and methods for this type of data. This paper gathers for the first time in a single paper the uncertainty models for segments and lines and positional accuracy assessment methods based on lines, incorporating the 3D case. Thus, this paper is intended as a reference document for those readers who are interested in this field.

El síndrome del folículo vacío es una situación en la cual, repetidamente, no se recuperan ovocitos durante la punción-aspiración folicular. Existen 2 tipos de síndrome del folículo vacío: el falso y el genuino. Se presenta el caso clínico de una paciente de 38 años con esterilidad primaria de un año de evolución. Ante un estudio básico de esterilidad normal, se realizaron 4 ciclos de IAC, que resultaron fallidos. Se decidió realizar FIV-ICSI, llevándose a cabo un total de 3 ciclos; el primero, protocolo de estimulación con análogo largo, y los ciclos restantes, protocolo de estimulación con antagonista. En todos los casos se constató la ausencia de errores en la medicación y unos niveles de gonadotropina coriónica humana óptimos. Se llega al diagnóstico de síndrome del folículo vacío genuino, pues a pesar de obtener un desarrollo folicular y niveles adecuados de gonadotropina coriónica humana prepunción, no se obtienen ovocitos durante la misma. La ovodonación actualmente es la mejor alternativa.