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Este libro radica en la necesidad de ofrecer a los profesionales de la salud, especialmente a los cirujanos y residentes en formación, una herramienta de consulta y aprendizaje práctico, actualizada y de fácil acceso adultos en todas las etapas de la vida.

Introduction and objectives In Spain, 0.3% of patients with hypertension are refractory to conventional treatment. The complications resulting from deficient control of this condition can lead to poor quality of life for the patient and considerable health care costs. Barostim is an implantable device designed to lower blood pressure in these patients. The aim of this study was to analyze the cost-effectiveness of Barostim compared with drug therapy in hypertensive patients refractory to conventional treatment (at least 3 antihypertensive drugs, including 1 diuretic agent). Methods We used a Markov model adapted to the epidemiology of the Spanish population to simulate the natural history of a cohort of patients with refractory hypertension over their lifetime. Data on the effectiveness of the treatments studied were obtained from the literature, and data on costs were taken from hospital administrative databases and official sources. Deterministic and probabilistic sensitivity analyses were conducted. Results Barostim increased the number of quality-adjusted life years by 0.78 and reduced the number of hypertension-associated clinical events. The incremental cost-effectiveness ratio in a cohort of men reached 68 726 euros per year of quality-adjusted life. One of the main elements that makes this technology costly is the need for battery replacement. The results were robust. Conclusions Barostim is not a cost-effective strategy for the treatment of refractory hypertension in Spain. The cost-effectiveness ratio could be improved by future reductions in the cost of the battery.

Resumen Introduccion y objetivos En Espana, el 0,3% de los pacientes hipertensos son refractarios al tratamiento convencional. Las complicaciones derivadas de un control deficiente se traducen en mala calidad de vida para el paciente y un coste importante para el sistema sanitario. Barostim es un dispositivo implantable que busca reducir la presion arterial de estos pacientes. El objetivo del presente estudio es analizar el coste-efectividad de Barostim comparado con terapia farmacologica en pacientes hipertensos refractarios al tratamiento convencional (al menos tres farmacos antihipertensivos, siendo uno de ellos un diuretico). Metodos Modelo de Markov adaptado a la epidemiologia de la poblacion espanola que simula la historia natural de una cohorte de pacientes con hipertension arterial refractaria a lo largo de su vida. Los datos sobre efectividad de los tratamientos se obtuvieron de la literatura y los de costes, de bases de datos administrativas hospitalarias y de fuentes oficiales. Se realizaron analisis de sensibilidad deterministico y probabilistico. Resultados Barostim redujo los eventos clinicos asociados a la hipertension y aumento en 0,78 el numero de anos de vida ajustados por calidad. El cociente de coste-efectividad incremental para una cohorte de varones alcanzo los 68.726 euros por ano de vida ajustado por calidad. Uno de los principales elementos que encarece la tecnologia es el coste del recambio de la bateria. Los resultados fueron robustos. Conclusiones Barostim no es una estrategia coste-efectiva para el tratamiento de la hipertension refractaria en Espana. Reducciones futuras en el precio de la bateria mejorarian su cociente de coste-efectividad.

17 pags., 12 figs., Continuous, real-time monitoring of surface seismic activity around the globe is of great interest for acquiring new insight into global tomography analyses and for recognition of seismic patterns leading to potentially hazardous situations. The already-existing telecommunication fiber optic network arises as an ideal solution for this application, owing to its ubiquity and the capacity of optical fibers to perform distributed, highly sensitive monitoring of vibrations at relatively low cost (ultra-high density of point sensors available with minimal deployment of new equipment). This perspective article discusses early approaches on the application of fiber-optic distributed acoustic sensors (DASs) for seismic activity monitoring. The benefits and potential impact of DAS technology in these kinds of applications are here illustrated with new experimental results on teleseism monitoring based on a specific approach: the so-called chirped-pulse DAS. This technology offers promising prospects for the field of seismic tomography due to its appealing properties in terms of simplicity, consistent sensitivity across sensing channels, and robustness. Furthermore, we also report on several signal processing techniques readily applicable to chirped-pulse DAS recordings for extracting relevant seismic information from ambient acoustic noise. The outcome presented here may serve as a foundation for a novel conception for ubiquitous seismic monitoring with minimal investment., This work was supported by the project FINESSE, Grant No. MSCA-ITN-ETN-722509; the DOMINO Water JPI project under the WaterWorks2014 cofounded call by EC Horizon 2020 and Spanish MINECO; the Comunidad de Madrid and FEDER Program under Grant No. SINFOTON2-CM: P2018/NMT-4326; the Spanish Government under Project Nos. TEC2015-71127-C2-2-R, RTI2018- 097957-B-C31, and RTI2018-097957-B-C33. M.R.F.M. and H.F.M. acknowledge financial support from the Spanish MICINN under Contract Nos. FJCI-2016-27881 and IJCI-2017-33856, respectively. M.A.S. acknowledges AC3E Basal Project No. FB0008 and thanks “Becas Iberoamérica Santander Universidades Convocatoria 2018” for supporting his research stay at the Universidad de Alcalá, Spain.

Sedentarism, overweight and malnutrition generate an increase in the production of reactive oxygen species leading to a state of chronic oxidative stress. In patients with type 2 diabetes mellitus, oxidative stress alters pancreatic insulin secretion and the actions of the hormone on target cells, contributing to the development of micro and macrovascular complications. During physical exertion a state of transient oxidative stress occurs. As a consequence, the organism generates multiple physiological adaptations to these repetitive stimuli. Physical exercise is beneficial for type 2 diabetes mellitus but there is a paucity of information about the effects of physical exercise on biomarkers of oxidative stress in patients with the disease. We herein try to elucidate if the effects of exercise on oxidative stress can help in the prevention and treatment of type 2 diabetes mellitus and which is the most effective modality of physical exercise to reduce oxidative stress markers.

Sedentarism, overweight and malnutrition generate an increase in the production of reactive oxygen species leading to a state of chronic oxidative stress. In patients with type 2 diabetes mellitus, oxidative stress alters pancreatic insulin secretion and the actions of the hormone on target cells, contributing to the development of micro and macrovascular complications. During physical exertion a state of transient oxidative stress occurs. As a consequence, the organism generates multiple physiological adaptations to these repetitive stimuli. Physical exercise is beneficial for type 2 diabetes mellitus but there is a paucity of information about the effects of physical exercise on biomarkers of oxidative stress in patients with the disease. We herein try to elucidate if the effects of exercise on oxidative stress can help in the prevention and treatment of type 2 diabetes mellitus and which is the most effective modality of physical exercise to reduce oxidative stress markers.

HTA is very well known by hospital doctors and managers in Spain, due to the long tradition of national/regional HTA Spanish agencies. Nevertheless, HB-HTA is still in its early phases. The assessment of health technologies (specifically medical devices, capital equipment, diagnostic tests and procedures) is very heterogeneous among hospitals, ranging from non existing approaches to methodologically robust procedures. The latter are representative of the raise of HB-HTA in Spain. In this chapter, the experience from three Spanish hospitals (two high-tech hospitals and one community hospital) in organizing and performing HB-HTA is described. Since differences in context exist among hospitals, HB-HTA is differently organized and performed. The impacts of these experiences are also presented as well as are the challenges and the natural future evolution of HB-HTA in Spain.

Seasonal influenza causes significant morbidity and mortality and has a substantial economic impact on the healthcare system. The main objective of this study was to compare the cost per patient for a rapid commercial PCR assay (Xpert® Flu) with an in-house real-time PCR test for detecting influenza virus. Community patients with influenza like-illness attending the Emergency Department (ED) as well as hospitalized patients in the Hospital Clínic of Barcelona were included. Costs were evaluated from the perspective of the hospital considering the use of resources directly related to influenza testing and treatment. For the purpose of this study, 366 and 691 patients were tested in 2013 and 2014, respectively. The Xpert® Flu test reduced the mean waiting time for patients in the ED by 9.1 hours and decreased the mean isolation time of hospitalized patients by 23.7 hours. This was associated with a 103€ (or about $113) reduction in the cost per patient tested in the ED and 64€ ($70) per hospitalized patient. Sensitivity analyses showed that Xpert® Flu is likely to be cost-saving in hospitals with different contexts and prices.