Sleep Apnea and Driving. Recommendations for Interpreting Spanish Regulations for Drivers

Road traffic accidents are one of the main causes of death worldwide and are clearly associated with sleepiness. Individuals with undiagnosed sleep apnea-hypopnea syndrome (SAHS) are among the population with a high risk of experiencing sleepiness at the wheel and, consequently, road traffic accidents. Treatment with continuous positive airway pressure (CPAP) has been shown to reduce the risk of accidents among drivers with SAHS. For this reason, the European Union has included this disease in the psychological and physical criteria for obtaining or renewing a driving license. To comply with this European Directive, Spain has updated its driving laws accordingly. To facilitate the implementation of the new regulations, a group of experts from various medical societies and institutions has prepared these guidelines that include questionnaires to screen for SAHS, diagnostic and therapeutic criteria, and physician's report templates.

[Sleep respiratory disorders, non-invasive ventilation and critical care in Archivos de Bronconeumología (June 2008-November 2009)]

The present study analyses the works published in Archivos de Bronconeumología from June 2008 to November 2009 that mention sleep disorders, non-invasive ventilation and critical care. The methodology used was to analyse the objectives of the works submitted, with their main results and the conclusions suggested by the authors, often putting forward the possibility of conducting new research studies. The review no only includes original articles but is also a reflection on the editorials, special articles and review works.

Health-Related Quality of Life of Patients Receiving Home May Mechanical Ventilation: The Spanish Version of the Severe Respiratory Insufficiency Questionnaire

OBJECTIVE

Home mechanical ventilation is used with patients with severe, chronic respiratory failure, a condition that has a serious impact on quality of life. The aim of this study was to produce a translation and cultural adaptation of the Severe Respiratory Insufficiency. Questionnaire for the Spanish population, the first health-related quality of life questionnaire specifically designed for patients receiving home mechanical ventilation.

METHODS

Four bilingual German-Spanish translators were used to translate and back-translate the questionnaire. Meetings were held with the translators following each step of the translation process to produce a single version that could be used in the next step. At the end of the process, the questionnaire was piloted to assess its comprehensibility. A scoring system using a scale of 1 (lowest) to 10 (highest) was used to rate both translation difficulty and the naturalness of the language produced. The equivalence of the original and translated items was also evaluated.

RESULTS

Three Spanish versions of the questionnaire were produced. Task difficulty was rated as quite low: the mean (SD) ratings were 1.4 (0.6) for translation and 2.2 (1.1) for back translation. The naturalness of the translated items was rated as very high, with scores improving with the successive versions (version 1, 8.4; version 2, 8.7; version 3, 9.1; P< .001). Thirty of the questionnaire items (61.2%) were judged to be fully equivalent, 13 (26.5%) to be similar, and 6 (12.2%) to be non-equivalent. The meaning conveyed by 5 of the items was changed or clarified during piloting.

CONCLUSIONS

The translation of the questionnaire using the translation-back-translation procedure has produced a version that is both comparable to the original and accessible to the Spanish population. Its validity is currently being tested in a multicenter study.

Emergency subtotal colectomy as treatment of choice in obstructing carcinomas of the left colon

PURPOSE

To assess the morbidity, mortality and function following emergency subtotal colectomy (ESC) with primary anastomosis in obstructing carcinomas of the left colon, to determine whether this technique is warranted as the current treatment of choice for this condition.

METHODS

Retrospective review of a series of 70 patients with obstructing carcinomas of the left colon who underwent an ESC with primary anastomosis between September 1989 and December 1996. Morbidity, mortality, hospital stay and functional results were analysed, as well as the percentage of patients submitted to this technique.

RESULTS

The use of ESC has steadily increased at our institution over the last few years, from 22% in 1990 to 84% of all the procedures performed for obstructing carcinomas of the left colon in 1995. The mortality rate of the series was 4.2%. Anastomotic leak rate was 10%, with only three major leaks. A prolonged obstructive ileus was a frequent and distressing complication (26%), and the main determinant of hospital stay. Average daily stool frequency on discharge from hospital was of 2 (range 1-6), with many patients having discontinued anti-diarrhoeal medications.

CONCLUSION

Emergency SC with primary anastomosis has evolved into the treatment of choice for most patients with acutely obstructing malignancies of the left colon at our institution. It can be performed with low mortality, a reasonable morbidity and good functional results.

Variability between and within laboratories in the analysis of structural chromosomal abnormalities

The frequency of structural chromosomal aberrations in two samples (AM and PM of the same day) from each of nine normal subjects, cultured in two different laboratories, was studied by six observers. The results were analyzed in order to determine the relative importance of inter- and intralaboratory factors in the variability of chromosomal abnormalities. In addition to the difference in the frequency of the abnormalities between the subjects studied, there were differences due to observers from different laboratories (P less than 0.01), as well as between laboratories (P less than 0.01). These results could be explained in part by insufficient agreement between observers from different laboratories and by differences in the quality of the method used.