Rev Esp Enferm Dig
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Propofol sedation is increasingly used for standard and advanced endoscopies due to its advantages over traditional sedation based on benzodiazepines and/or opioids. These include a better sedation, greater patient cooperation, and higher patient satisfaction for most endoscopic procedures; it also decreases time to sedation and decreases recovery and discharge times. As anesthesiologists have typically provided propofol-based sedation, the increase in its use is limited by anesthesiologists' availability and cost. ⋯ This Editorial puts into perspective discussions that have recently taken place in Spain about the safety of non-anesthesiologist administration of propofol. It aims at refocusing the debate on facts, with the hope that an agreement between anesthesiologists, endoscopists and nurses will be achieved. Anesthesiologists' support is essential to ensure that the transition that endoscopists are making from traditional to propofol sedation is safe.
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It is universally accepted that deep sedation involves more risks than light-to-moderate sedation. Deep sedation for endoscopic explorations is normally provided by anesthesiologists in Spain and in most countries of the European Unión. The present debate about deep sedation-anesthesia states goes beyond the topic of cardiovascular and respiratory adverse events, and targets the cognitive consequences and global increased mortality of uncontrolled sedation states, especially in specific fragile populations. We consider that strong recomendations for sedative techniques in endoscopic procedures should be made in Spain taking in consideration to two basic principles: 1) according to published evidence concerning patient safety, deep sedation must be an unequivocal responsibility of the anesthesiologist, and 2) we must define which patients are candidates for deep sedation during endoscopic procedures, as this will help to regulate patient flow in clinics and to reduce adverse effects associated with overtreatment of patients.
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Observational Study
Readmissions due to acute biliary edematous pancreatitis in patients without cholecystectomy.
Analyzing the readmission of patients with acute biliary edematous pancreatitis (ABEP) without cholecystectomy despite a previous episode of mild acute gallstone pancreatitis or lithiasic cholecystitis. Calculating the health costs associated with the non-performance of cholecystectomy. ⋯ Not performing a cholecystectomy within two weeks after a first episode of mild ABEP or cholecystitis contributes to patient readmission due to recurrent pancreatitis, resulting in avoidable treatment costs.
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Capsule endoscopy is an extended tool for the diagnosis of small bowel Crohn's disease. However, factors associated with positive findings of this technique have not been well established. Our aim is to asses which factors are associated with a better diagnostic yield of capsule endoscopy in suspected small bowel Crohn's disease. ⋯ C-reactive protein and fecal calprotectin are appropriate biomarkers for selecting patients with suspected Crohn's disease of the small bowel for capsule endoscopy studies.
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Observational Study
Transcultural adaptation and validation of the Celiac Dietary Adherence Test. A simple questionnaire to measure adherence to a gluten-free diet.
A gluten-free diet is to date the only treatment available to celiac disease sufferers. However, systematic reviews indicate that, depending on the method of evaluation used, only 42% to 91% of patients adhere to the diet strictly. Transculturally adapted tools that evaluate adherence beyond simple self-informed questions or invasive analyses are, therefore, of importance. The aim is to obtain a Spanish transcultural adaption and validation of Leffler's Celiac Dietary Adherence Test. ⋯ The Spanish version of the Celiac Dietary Adherence Test shows appropriate psychometric properties and is, therefore, suitable for studying adherence to a gluten-free diet in clinical and research environments.