Prediction of local and metastatic recurrence in solitary fibrous tumor: construction of a risk calculator in a multicenter cohort from the French Sarcoma Group (FSG) database.

BACKGROUND: Solitary fibrous tumors (SFT) are rare unusual ubiquitous soft tissue tumors that are presumed to be of fibroblastic differentiation. At present, the challenge is to establish accurate prognostic factors. PATIENTS AND METHODS: A total of 214 consecutive patients with SFT diagnosed in 24 participating cancer centers were entered into the European database (www.conticabase.org) to perform univariate and multivariate analysis for overall survival (OS), local recurrence incidence (LRI) and metastatic recurrence incidence (MRI) by taking competing risks into account. A prognostic model was constructed for LRI and MRI. Internal and external validations of the prognostic models were carried out. An individual risk calculator was carried out to quantify the risk of both local and metastatic recurrence. RESULTS: We restricted our analysis to 162 patients with local disease. Twenty patients (12.3%) were deceased at the time of analysis and the median OS was not reached. The LRI rates at 10 and 20 years were 19.2% and 38.6%, respectively. The MRI rates at 10 and 20 years were 31.4% and 49.8%, respectively. Multivariate analysis retained age and mitotic count tended to significance for predicting OS. The factors influencing LRI were viscera localization, radiotherapy and age. Mitotic count, tumor localization other than limb and age had independent values for MRI. Three prognostic groups for OS were defined based on the number of unfavorable prognostic factors and calculations were carried out to predict the risk of local and metastatic recurrence for individual patients. CONCLUSION: LRI and MRI rates increased between 10 and 20 years so relapses were delayed, suggesting that long-term monitoring is useful. This study also shows that different prognostic SFT sub-groups could benefit from different therapeutic strategies and that use of a survival calculator could become standard practice in SFTs to individualize treatment based on the clinical situation.

Using knowledge as the basis for evidence-based practice in primary care nurses.

AIM: The aim of this study was to explore the perception of primary care nurses regarding the need and use of knowledge from research, as a basis for evidence-based practice in their workplace. Additionally, the study aimed to determine which factors might hinder or enable implementation into daily practice. BACKGROUND: Evidence-based practice involves integrating best results in research with clinical experience, which enables us to provide a higher quality of care, as well as to optimize the care given. International studies show that nurses feel that there are still many barriers that hinder their doing research and incorporating new findings into clinical practice; although in the field of primary care, few studies have been carried out. METHODS: This descriptive qualitative study design used focus groups to collect data. This study was carried out in Spanish primary care centres. Forty-six registered nurses took part in this study and were divided into five focus groups. RESULTS: Three significant themes emerged: awareness of the need to use research, nurses as knowledge-generation agents and motivation to use research despite barriers. LIMITATIONS: A limited number of participants and a convenience sample were used. CONCLUSION: Nurses recognize that professional health care must be based on evidence obtained from daily work - both originated by their colleagues and by themselves - and they are willing to work on it although they perceive a lack of competence for this purpose and demand support from their institutions. IMPLICATIONS FOR NURSING POLICY: Primary care institutions should empower nursing coordinators as leaders of evidence-based practice and implicate clinical nurses from the beginning on the implementation of guidelines.

Concurrent chemo-radiotherapy in elderly patients: tolerance and compliance in a series of 137 patients.

INTRODUCTION: Aggressive cancer treatment is a challenge in elderly patients. The present study aims to assess tolerance in terms of acute toxicity and compliance of concurrent chemo-radiotherapy (cCRT) in a series of patients aged ≥70 years. MATERIALS AND METHODS: Clinical records of patients aged ≥70 years who underwent cCRT between January 2005 and December 2013 were reviewed. Concurrent CRT had curative intent in 134 patients (97.8 %) and palliative intent in 3 patients (2.2 %). Chemotherapy (CT) drugs and schedule were selected according to tumor histology. Radiotherapy median dose was 45.0 Gy (range 11-70 Gy) for curative purposes and 54 Gy (range 40-56 Gy) for palliative purposes. Incidence of acute toxicity and compliance to cCRT were analyzed and correlated with age, Karnofsky Performance Status (KPS), and Charlson Comorbidity Index (CCI). RESULTS: Overall, 137 patients, 82 males (60 %) and 55 females (40 %), median age 74 years (range 70-90 years) were analyzed. Concurrent CRT schedule was completed by 132 patients (96.4 %). Thirty-one of these patients (23.5 %) temporarily interrupted treatment. Hematological toxicity with grade ≥1 was observed in 25 patients (18.2 %), gastrointestinal toxicity in 55 (40.1 %), and genitourinary in 13 (9.5 %). Mucositis with grade ≥1 was recorded in 19 patients (13.9 %). No statistical significant correlation between KPS, CCI, and toxicity was found. A correlation trend between mucositis and patient age (p = 0.05) was observed. CONCLUSION: Concurrent CRT for elderly was feasible and quite well tolerated. Great attention in prescribing CT dose should be paid to limit acute toxicity.

Perception of Spanish primary healthcare nurses about evidence-based clinical practice: a qualitative study.

BACKGROUND: Although evidence-based clinical practice constitutes a priority for healthcare services in many countries within the last few years, there is a general lack of implementation of evidence-based clinical practice in nursing care, especially in primary health care. Few qualitative studies concerning the influencing factors on evidence-based clinical practice for community nurses have been carried out. AIM: This study examined the perception of nurses in Spanish primary health care with regard to the knowledge, advantages and barriers within the application process with evidence-based clinical practice. METHODS: We used a descriptive qualitative study with focus groups to collect data. Forty-six primary care nurses took part in this study and they were distributed into five focus groups. RESULTS: Five main topics arose from the results achieved: knowledge and development of evidence-based clinical practice, evidence searching, evidence dissemination, advantages of use of evidence-based clinical practice, and barriers for its application and implementation. Participants had a positive attitude towards evidence-based practice, although they used this infrequently because of lack of competence and organizational support for its application. CONCLUSION: Our participants are increasingly determined to take into account evidence within the decision-making processes in their usual clinical practice. We consider it advisable to develop specialized training strategies as well as provide necessary resources for the implementation of evidence-based clinical practice duly adapted to the field of primary health care. IMPLICATIONS FOR NURSING AND HEALTH POLICY: This study highlights the existing gap in translating knowledge to practice and its potential implications in the effectiveness of nursing interventions and decision making in primary health care, and thus its implications for education policy.

[Endotrachael aspiration protocol in patients with serious cranial trauma. study of neurophysiological variables]. / Protocolo de aspiración endotraqueal en pacientes con trauma craneal grave. Estudio de variables neurofisiológicas.

Aspiration of tracheobronchial secretions can cause noxious effects on neurophysiological variables. Different studies that refer to aspiration of secretions in Serious Cranial Trauma use hyperinsuflation and hyperoxygenation to minimize its repercussion on Intracranial Pressure and thus try to not contribute to the secondary lesion. After reviewing these studies, a protocol of tracheobronchial secretion aspiration was performed in our ICU in patients with serious cranial trauma subjected to mechanical ventilation in order to assess the effect of the aspiration of secretions in the neurophysiological variables following homogeneous and standardized guidelines. Neurological, hemodynamic, oxygenation and ventilation variables were analyzed before, during and after aspiration of secretions. When the results were compared before and during this, we observed a decrease in the Intracranial Pressure with increase of Cerebral Perfusion Pressure (due to increase of Mean Blood Pressure), maintaining the levels of PaCO2 and jugular saturation of O2, with an increase in the airway pressures. After finishing the aspiration process, all the affected values recovered. It is concluded that the aspiration of tracheobronchial secretions in patients with Severe Cranial Trauma, after standardized hyperinsuflation and hyperoxygenation, does not alter the hydrodynamics or brain use of O2.

Photoinduced formation of beta-oxy-alpha,alpha-disubstituted-alpha-amino acid derivatives from ketoximes.

[reaction: see text] The first intermolecular radical addition onto ketoxime ethers is described. beta-Oxygenated quaternary alpha-amino acid derivatives IotaIota were obtained upon irradiation of alpha-alkoxycarbonyl ketoxime ethers Iota in the presence of suitable alpha-alkoxy carbon radical precursors and a sensitizer.