BACKGROUND: Transcatheter Aortic Valve Implantation (TAVI) has changed the treatment paradigm of the aortic stenosis (AS). It has become the treatment of choice in patients with symptomatic AS and surgical high risk, and a valid alternative to surgical aortic valve replacement in patients with low and medium surgical risk. Despite numerous evidence on clinical results, indications and benefits, only a few studies analyse it from patient's perspective and the impact of TAVI on them. The objective of this study is to evaluate the experience of patients undergoing TAVI. METHODS: Cross-sectional, descriptive observational study in two Spanish hospitals, with a establish Nurse TAVI program, with 100 patients undergoing TAVI. A specific questionnaire was designed (VALVEX questionnaire) and a pilot study was conducted by a multidisciplinary team of doctors, nurses and patients. The questionnaire was given to patients at 30 days after TAVI procedure during the follow up at the TAVI nurse clinic. RESULTS: The study demonstrated a mean satisfaction of 9 for the TAVI program, with 96% of patients that would recommend TAVI to other patients. Patients scored a high satisfaction on the information received prior to the procedure. During the procedure and admission, the satisfaction was high in relation to the care received. During the follow up, satisfaction was high in relation to the role of the TAVI nurse, for the information and continuation of care during the procedure, in reducing anxiety, organising their admission and understanding the process. However, questions with less scores were related to hospital catering, delay between diagnosed and treatment, and patient decision-making process. CONCLUSION The evaluation of patient experience allows us to improve the information given to the patient during their TAVI process and it can also allow patients to be more relax, aware and prepared for the procedure. Continuous follow up enables monitoring of patient recovery and helps to discuss any doubts improving patient's satisfaction. The use of PREMs and PROMs associated to TAVI pathway combined with an active participation of the patient on the design of the questionnaire is essential for keeping the patient in the centre of the TAVI pathway.

BACKGROUND: Patients aged 85 years or older admitted for heart failure (HF) have increased enormously due to improved survival in this disease. However, few studies assess the characteristics, treatments, and prognosis of very elderly patients admitted for acute HF. METHODS: This study is a retrospective analysis of the EPICTER registry, that included patients admitted for acute HF in 74 Spanish hospitals. For this analysis, a total of 1887 patients were included and divided into 2 groups: 85 years or older (very elderly, 680 patients) and those under 85 years. RESULTS: Compared to patients < 85 years, very elderly patients were more frequently women, had more hypertension and disease cerebrovascular disease, and less presence of chronic obstructive pulmonary disease (COPD), diabetes, and acute myocardial infarction. There were no differences in symptoms, except for delirium, significantly more common in very elderly patients. Management of these patients was more conservative and died more than the younger ones (41% vs. 25%, P < 0.001). The predictor variables of mortality in very elderly patients were the presence of COPD and peripheral arterial disease, delirium, and estimated survival of less than 6 months assessed by the physician in charge of the patient care. CONCLUSION Very elderly patients admitted for HF differ from younger ones in comorbidities, management, and symptoms, and have higher mortality. The presence of delirium, peripheral arterial disease, and COPD worsen the prognosis in these patients and can help to adapt the therapeutic effort and place emphasis on adequate symptom control.

Objectives: . Ménière disease (MD) is an idiopathic disorder that affects hearing and inner ear balance. Intratympanic gentamicin (ITG) is recognized as an effective treatment for uncontrolled MD characterized by persistent vertigo attacks despite therapy. The video head impulse test (vHIT) and skull vibration-induced nystagmus (SVIN) are validated methods for evaluating vestibular function. A progressive linear relationship has been identified between the slow-phase velocity (SPV) of SVIN determined using a 100-Hz skull vibrator and the gain difference (healthy ear/affected ear) measured by vHIT. The aim of this study was to ascertain whether the SPV of SVIN was associated with the recovery of vestibular function following ITG treatment. Consequently, we sought to determine whether SVIN could predict the onset of new vertigo attacks in patients with MD who were treated with ITG. Methods: . A prospective longitudinal case-control study was conducted. Several variables were recorded post-ITG and throughout the follow-up period, followed by statistical analyses. Two groups were compared: patients who experienced vertigo attacks 6 months after ITG and those who did not. Results: . The sample comprised 88 patients diagnosed with MD who underwent ITG treatment. Of the 18 patients who experienced recurring vertigo attacks, 15 demonstrated gain recovery in the affected ear. However, all 18 patients exhibited a decrease in the SPV of SVIN. Conclusion . The SPV of SVIN may be more sensitive than vHIT in identifying the recovery of vestibular function following ITG administration. To our knowledge, this is the first study to illustrate the link between a reduction in SPV and the likelihood of vertigo episodes in patients with MD who have been treated with ITG.

BACKGROUND: Sacral nerve stimulation is a therapeutic option with demonstrated efficacy for conditions presenting with perineal pain caused by different etiologies. We aimed to assess whether a sacral electrode (InterStim(R), Medtronic, Minneapolis, MN, USA) inserted through the caudal pathway is able to offer an acceptable level of sacral stimulation and rate of catheter migration. METHODS: We present 12 patients with pelvic pain who received sacral neuromodulation via the sacral hiatus with the InterStim electrode. We evaluated patient satisfaction as well as migration and removal of the electrode, if necessary. RESULTS: Our experience included 12 patients, 10 women and two men, with a mean age of 60 years. In eight of the 12 patients, the initial therapy was effective, and the final system implantation was performed. During subsequent follow-up, patient satisfaction was good. To date, there have been no cases of electrode displacement or migration. CONCLUSIONS: The caudal insertion of the InterStim electrode, with its own fixation system, and initially designed for transsacral insertion, appears in our experience to be a satisfactory option which can minimize electrode displacements, achieving similar results in therapeutic efficacy and causing no difficulties in removal.
Catheters ; Electrodes* ; Female ; Follow-Up Studies ; Humans ; Implantable Neurostimulators ; Male ; Pain Clinics* ; Patient Satisfaction ; Pelvic Pain ; Perineum ; Sacrococcygeal Region ; Sacrum ; Spinal Cord Stimulation

PURPOSE: The aim of this study was to analyze the anatomical dimensions of the buccal bone walls of the aesthetic maxillary region for immediate implant placement, based upon cone-beam computed tomography (CBCT) scans in a sample of adult patients. METHODS: Two calibrated examiners analyzed a sample of 50 CBCT scans, performing morphometric analyses of both incisors and canines on the left and right sides. Subsequently, in the sagittal view, a line was traced through the major axis of the selected tooth. Then, a second line (E) was traced from the buccal to the palatal wall at the level of the observed bone ridges. The heights of the buccal and palatal bone ridges were determined at the major axis of the tooth. The buccal bone thickness was measured across five lines. The first was at the level of line E. The second was at the most apical point of the tooth, and the other three lines were equidistant between the apical and the cervical lines, and parallel to them. Statistical analysis was performed with a significance level of P< or =0.05 for the bone thickness means and standard deviations per tooth and patient for the five lines at varying depths. RESULTS: The means of the buccal wall thicknesses in the central incisors, lateral incisors and canines were 1.14+/-0.65 mm, 0.95+/-0.67 mm and 1.15+/-0.68 mm, respectively. Additionally, only on the left side were significant differences in some measurements of buccal bone thickness observed according to age and gender. However, age and gender did not show significant differences in heights between the palatal and buccal plates. In a few cases, the buccal wall had a greater height than the palatal wall. CONCLUSIONS: Less than 10% of sites showed more than a 2-mm thickness of the buccal bone wall, with the exception of the central incisor region, wherein 14.4% of cases were > or =2 mm.
Adult ; Axis, Cervical Vertebra ; Cone-Beam Computed Tomography* ; Esthetics, Dental ; Humans ; Incisor ; Tooth