Electronic health records and patient registries in medical oncology departments in Spain

Purpose We aimed to evaluate the current situation of electronic health records (EHRs) and patient registries in the oncology departments of hospitals in Spain. Methods This was a cross-sectional study conducted from December 2018 to September 2019. The survey was designed ad hoc by the Outcomes Evaluation and Clinical Practice Section of the Spanish Society of Medical Oncology (SEOM) and was distributed to all head of medical oncology department members of SEOM. Results We invited 148 heads of oncology departments, and 81 (54.7%) questionnaires were completed, with representation from all 17 Spanish autonomous communities. Seventy-seven (95%) of the respondents had EHRs implemented at their hospitals; of them, over 80% considered EHRs to have a positive impact on work organization and clinical practice, and 73% considered that EHRs improve the quality of patient care. In contrast, 27 (35.1%) of these respondents felt that EHRs worsened the physician–patient relationship and conveyed an additional workload (n = 29; 37.6%). Several drawbacks in the implementation of EHRs were identified, including the limited inclusion of information on both outpatients and inpatients, information recorded in free text data fields, and the availability of specific informed consent. Forty-six (56.7%) respondents had patient registries where they recorded information from all patients seen in the department. Conclusion Our study indicates that EHRs are almost universally implemented in the hospitals surveyed and are considered to have a positive impact on work organization and clinical practice. However, EHRs currently have several drawbacks that limit their use for investigational purposes (AU)

Electronic health records and patient registries in medical oncology departments in Spain.

PURPOSE: We aimed to evaluate the current situation of electronic health records (EHRs) and patient registries in the oncology departments of hospitals in Spain. METHODS: This was a cross-sectional study conducted from December 2018 to September 2019. The survey was designed ad hoc by the Outcomes Evaluation and Clinical Practice Section of the Spanish Society of Medical Oncology (SEOM) and was distributed to all head of medical oncology department members of SEOM. RESULTS: We invited 148 heads of oncology departments, and 81 (54.7%) questionnaires were completed, with representation from all 17 Spanish autonomous communities. Seventy-seven (95%) of the respondents had EHRs implemented at their hospitals; of them, over 80% considered EHRs to have a positive impact on work organization and clinical practice, and 73% considered that EHRs improve the quality of patient care. In contrast, 27 (35.1%) of these respondents felt that EHRs worsened the physician-patient relationship and conveyed an additional workload (n = 29; 37.6%). Several drawbacks in the implementation of EHRs were identified, including the limited inclusion of information on both outpatients and inpatients, information recorded in free text data fields, and the availability of specific informed consent. Forty-six (56.7%) respondents had patient registries where they recorded information from all patients seen in the department. CONCLUSION: Our study indicates that EHRs are almost universally implemented in the hospitals surveyed and are considered to have a positive impact on work organization and clinical practice. However, EHRs currently have several drawbacks that limit their use for investigational purposes. CLINICAL TRIAL REGISTRATION: Not applicable.

Xantoma intraóseo pelviano: reporte de un caso y revisión de la literatura / Pelvic intraosseous xanthoma: a case report and literature review

El xantoma intraóseo (XIO) es un tumor óseo benigno extremadamente raro. En la histología se caracteriza por presentar macrófagos mononucleares, abundantes células espumosas y células gigantes multinucleadas. Puede aparecer asociado a otras enfermedades (XIO secundario), principalmente a desórdenes lipídicos, o en forma aislada (XIO primario). Los XIO son lesiones líticas expansivas que a menudo se encuentran en pacientes con condiciones hiperlipidémicas. En la mayoría de los casos la evaluación inicial se realiza con radiografía, aunque otros procedimientos pueden ser necesarios para confirmar el diagnóstico. Se presenta el caso de un hombre de 48 años que consultó por lumbalgia con irradiación al miembro inferior derecho e impotencia funcional de 3 meses de evolución. Tenía hallazgos imagenológicos de XIO en el hueso ilíaco derecho, sin hiperlipidemia o lesiones preexistentes. Se llevó a cabo la extirpación total del tumor y el posterior estudio histopatológico de la pieza operatoria confirmó el diagnóstico. El tratamiento resultó exitoso. El objetivo de este artículo es describir los hallazgos clínicos e imagenológicos (radiografía, resonancia magnética, tomografía computada y medicina nuclear) de un XIO primario y su tratamiento. Además, realizamos una breve revisión de la literatura.

Abstract Intraosseous xanthoma is an extremely rare benign bone tumor. Histology shows mononuclear macrophages, abundant foam cells and multinucleated giant cells. The intraosseous xanthoma may appear associated with other diseases (secondary intraosseous xanthoma), mainly lipid disorders or without an underlying lipid disorder (primary intraosseous xanthoma). The intraosseous xanthoma is a lytic, expansive tumor, often seen in patients with hyperlipidemic conditions. In most cases, the initial evaluation is performed with X-ray, although other procedures may be necessary to confirm the diagnosis. We report the case of a man aged 48, who consulted for back pain radiating to the right leg and functional disability 3 months duration, with imaging findings in the right iliac XIO in the absence of pre-existing injuries or hyperlipidemic conditions, so surgery for total removal of the tumor was performed with histological examination of the surgical specimen, confirming the preoperative diagnosis of XIO. Such treatment resulted curative. The aim of this article is to describe the clinical, imaging findings (RX, MRI, CT, nuclear medicine) and the course of treatment of a committing the iliac primary intraosseous xanthoma a and a normolipidemic patient brief review of the literature.

Xantoma intraóseo pelviano: reporte de un caso y revisión de la literatura

El xantoma intraóseo (XIO) es un tumor óseo benigno extremadamente raro. En la histología se caracteriza por presentar macrófagos mononucleares, abundantes células espumosas y células gigantes multinucleadas. Puede aparecer asociado a otras enfermedades (XIO secundario), principalmente a desórdenes lipídicos, o en forma aislada (XIO primario). Los XIO son lesiones líticas expansivas que a menudo se encuentran en pacientes con condiciones hiperlipidémicas. En la mayoría de los casos la evaluación inicial se realiza con radiografía, aunque otros procedimientos pueden ser necesarios para confirmar el diagnóstico. Se presenta el caso de un hombre de 48 años que consultó por lumbalgia con irradiación al miembro inferior derecho e impotencia funcional de 3 meses de evolución. Tenía hallazgos imagenológicos de XIO en el hueso ilíaco derecho, sin hiperlipidemia o lesiones preexistentes. Se llevó a cabo la extirpación total del tumor y el posterior estudio histopatológico de la pieza operatoria confirmó el diagnóstico. El tratamiento resultó exitoso. El objetivo de este artículo es describir los hallazgos clínicos e imagenológicos (radiografía, resonancia magnética, tomografía computada y medicina nuclear) de un XIO primario y su tratamiento. Además, realizamos una breve revisión de la literatura.(AU)

Abstract Intraosseous xanthoma is an extremely rare benign bone tumor. Histology shows mononuclear macrophages, abundant foam cells and multinucleated giant cells. The intraosseous xanthoma may appear associated with other diseases (secondary intraosseous xanthoma), mainly lipid disorders or without an underlying lipid disorder (primary intraosseous xanthoma). The intraosseous xanthoma is a lytic, expansive tumor, often seen in patients with hyperlipidemic conditions. In most cases, the initial evaluation is performed with X-ray, although other procedures may be necessary to confirm the diagnosis. We report the case of a man aged 48, who consulted for back pain radiating to the right leg and functional disability 3 months duration, with imaging findings in the right iliac XIO in the absence of pre-existing injuries or hyperlipidemic conditions, so surgery for total removal of the tumor was performed with histological examination of the surgical specimen, confirming the preoperative diagnosis of XIO. Such treatment resulted curative. The aim of this article is to describe the clinical, imaging findings (RX, MRI, CT, nuclear medicine) and the course of treatment of a committing the iliac primary intraosseous xanthoma a and a normolipidemic patient brief review of the literature.(AU)

Robust gene signatures from microarray data using genetic algorithms enriched with biological pathway keywords.

Genetic algorithms are widely used in the estimation of expression profiles from microarrays data. However, these techniques are unable to produce stable and robust solutions suitable to use in clinical and biomedical studies. This paper presents a novel two-stage evolutionary strategy for gene feature selection combining the genetic algorithm with biological information extracted from the KEGG database. A comparative study is carried out over public data from three different types of cancer (leukemia, lung cancer and prostate cancer). Even though the analyses only use features having KEGG information, the results demonstrate that this two-stage evolutionary strategy increased the consistency, robustness and accuracy of a blind discrimination among relapsed and healthy individuals. Therefore, this approach could facilitate the definition of gene signatures for the clinical prognosis and diagnostic of cancer diseases in a near future. Additionally, it could also be used for biological knowledge discovery about the studied disease.

Concurrent radiotherapy plus epidermal growth factor receptor inhibitors in patients with human papillomavirus-related head and neck cancer.

PURPOSE: Concurrent radio-chemotherapy (RT-CT) is the standard treatment for locally advanced head and neck squamous cell carcinoma (LA-HNSCC), but RT plus epidermal growth factor receptor (EGFR) inhibitors is an effective option when CT is not appropriate. Human papillomavirus (HPV) is associated with an improved prognosis in LA-HNSCC; however, it has not been fully studied as a prognostic factor after RT + EGFR inhibitors. EXPERIMENTAL DESIGN: Immunohistochemical expression of p16INK4A and PCR of HPV16 DNA were retrospectively analyzed in tumor blocks from 52 stage III/IV LA-HNSCC patients treated with RT + EGFR inhibitors. Disease-free survival (DFS) and overall survival (OS) were analyzed by the Kaplan-Meier method. RESULTS: DNA of HPV16 was found in six of 52 tumors (12 %) and p16 positivity in eight tumors (15 %). After a median follow-up time of 45 months (6-110), p16-positive patients treated with RT + EGFR inhibitors showed an improved DFS (2-year DFS 75 vs. 44 %, HR 0.25, 95 % CI 0.06-0.99, p = 0.047) compared with p16-negative patients. These differences were outperformed when compared by HPV16 status (2-year OS rates of 83 vs. 58 %, HR 0.17, 95 % CI 0.02-0.99, p = 0.049 and 2-year DFS rates of 83 vs. 45 %, HR 0.17, 95 % CI 0.02-0.99, p = 0.049). In the Cox regression analysis with OS as the end point, ECOG 0-1 was the only prognostic factor independently associated with a good prognosis in the multivariable analysis. CONCLUSION: In this study, p16/HPV16-positive patients with LA-HNSCC treated with RT + EGFR inhibitors showed a better survival, not confirmed in multivariate analysis.

Addressing critical issues in the development of an Oncology Information System.

PURPOSES: This paper presents the experience on the design and implementation of a user-centered Oncology Information System developed for the Medical Oncology Department at the "Hospital Universitario Virgen de la Victoria", in Málaga, Spain. The project focused on the aspects considered in the literature as critical factors for a successful deployment and usage of a health information system. METHODS: System usability, adequate technology, integration of clinical routines, real-time statistical analysis of data, information confidentiality and standard protocol-based external interconnection were the key aspects considered. RESULTS: The developed system is based on a web application with a modular and layered architecture accounting for usability, ease of maintenance and further system development. Evaluation of system usability was carried at three and fifteen months after system deployment to analyze the advantages/disadvantages experienced by the end-users. CONCLUSIONS: A thorough prior analysis of clinical activities and workflows, the use of the adequate technology, and the availability of data analysis tools will almost guarantee success in the deployment of an Oncology Information System.

WIMP: web server tool for missing data imputation.

The imputation of unknown or missing data is a crucial task on the analysis of biomedical datasets. There are several situations where it is necessary to classify or identify instances given incomplete vectors, and the existence of missing values can much degrade the performance of the algorithms used for the classification/recognition. The task of learning accurately from incomplete data raises a number of issues some of which have not been completely solved in machine learning applications. In this sense, effective missing value estimation methods are required. Different methods for missing data imputations exist but most of the times the selection of the appropriate technique involves testing several methods, comparing them and choosing the right one. Furthermore, applying these methods, in most cases, is not straightforward, as they involve several technical details, and in particular in cases such as when dealing with microarray datasets, the application of the methods requires huge computational resources. As far as we know, there is not a public software application that can provide the computing capabilities required for carrying the task of data imputation. This paper presents a new public tool for missing data imputation that is attached to a computer cluster in order to execute high computational tasks. The software WIMP (Web IMPutation) is a public available web site where registered users can create, execute, analyze and store their simulations related to missing data imputation.

[Do we agree on the technical quality of our chest X-rays? A radiologist, an expert in X-ray diagnosis, and a family doctor try to find out]. / 'Estamos de acuerdo con la calidad técnica de nuestras radiografías de tórax? Un radiólogo, un técnico especialista en radiodiagnóstico y un médico de familia intentan corroborarlo.

OBJECTIVE: To appraise the degree of concordance in the interpretation of the technical quality of chest x-rays at a health centre between an expert in x-ray diagnosis, a family doctor, and a radiologist. DESIGN: Transversal study. Setting. Primary care. Cartuja Health Centre, Granada, Spain. PARTICIPANTS: Patients at the Cartuja Health Centre who had a simple chest x-ray in 2002. 150 studies were chosen by simple randomised sampling. Two were rejected because they dealt with a repeat examination of the same patient and seven because they did not reach minimum quality. The final sample was 141 x-rays. MAIN MEASUREMENTS: The observers filled in independently, for each examination, an 11-item protocol on the technical quality of the images. The kappa index between pairs of observers was calculated for each item, as was the overall kappa index. RESULTS: 96% of the examinations were conducted with large x-ray plates (3543). There was only acceptable or good concordance between the 3 observers in 2 questions (kappa, 0.559-0.858). In 5 questions concordance was homogeneously low (kappa, 0.034-0.375). In some questions there was a strong discrepancy between the appraisal of the expert and that of the 2 other observers. CONCLUSIONS: General concordance can be considered low, although it is somewhat greater between the radiologist and the family doctor than between either of these and the expert. This poses the need to improve professional training in evaluation of the technical quality of images. In addition, there was unnecessary expense in large-size x-ray plates.

¿Estamos de acuerdo con la calidad técnica de nuestras radiografías de tórax? Un radiólogo, un técnico especialista en radiodiagnóstico y un médico de familia intentan corroborarlo / Do we agree on the technical quality of our chest X-ray? A radiologist, an expert in X-ray diagnosis, and a family doctor try to find out

Objetivo. Valorar el grado de concordancia en la interpretación de la calidad técnica de las radiografías de tórax de un centro de salud entre el técnico especialista en radiodiagnóstico (TER), el médico de familia y el radiólogo. Diseño. Estudio transversal. Emplazamiento. Atención primaria. Centro de Salud de Cartuja en Granada. Participantes. Pacientes del Centro de Salud de Cartuja con estudio radiológico simple de tórax durante 2002. Mediante muestreo aleatorio simple se seleccionaron 150 estudios. Se rechazaron 2 por tratarse de exploraciones repetidas del mismo paciente y 7 porque no presentaban una calidad mínima. La muestra final fue de 141 exploraciones. Mediciones principales. Los observadores cumplimentaron independientemente, para cada exploración, un protocolo de 11 ítems sobre calidad técnica de la imagen. Para cada ítem se calculó el índice kappa entre parejas de observadores, así como el índice kappa global. Resultados. El 96% de las exploraciones fue realizado con placas radiográficas de gran tamaño (35 x 43). Sólo en 2 preguntas hubo una concordancia aceptable o buena entre los 3 observadores (kappa = 0,559-0,858). En 5 preguntas, la concordancia fue homogéneamente baja (kappa = 0,034-0,375). En algunas preguntas se apreció una fuerte discrepancia entre la valoración del TER y la realizada por los otros 2 observadores. Conclusiones. La concordancia general puede considerarse baja, aunque algo mayor entre el radiólogo y el médico de familia que entre cada uno de éstos y el TER. Esto plantea la necesidad de mejorar la formación de los profesionales en cuanto a la valoración de la calidad técnica de las imágenes. Además, se detecta un gasto innecesario de placas radiográficas de gran tamaño

Objective. To appraise the degree of concordance in the interpretation of the technical quality of chest x-rays at a health centre between an expert in x-ray diagnosis, a family doctor, and a radiologist. Design. Transversal study. Setting. Primary care. Cartuja Health Centre, Granada, Spain. Participants. Patients at the Cartuja Health Centre who had a simple chest x-ray in 2002. 150 studies were chosen by simple randomised sampling. Two were rejected because they dealt with a repeat examination of the same patient and seven because they did not reach minimum quality. The final sample was 141 x-rays. Main measurements. The observers filled in independently, for each examination, an 11-item protocol on the technical quality of the images. The kappa index between pairs of observers was calculated for each item, as was the overall kappa index. Results. 96% of the examinations were conducted with large x-ray plates (35 x 43). There was only acceptable or good concordance between the 3 observers in 2 questions (kappa, 0.559-0.858). In 5 questions concordance was homogeneously low (kappa, 0.034-0.375). In some questions there was a strong discrepancy between the appraisal of the expert and that of the 2 other observers. Conclusions. General concordance can be considered low, although it is somewhat greater between the radiologist and the family doctor than between either of these and the expert. This poses the need to improve professional training in evaluation of the technical quality of images. In addition, there was unnecessary expense in large-size x-ray plates

Improvement of breast cancer relapse prediction in high risk intervals using artificial neural networks.

The objective of this study is to compare the predictive accuracy of a neural network (NN) model versus the standard Cox proportional hazard model. Data about the 3811 patients included in this study were collected within the 'El Alamo' Project, the largest dataset on breast cancer (BC) in Spain. The best prognostic model generated by the NN contains as covariates age, tumour size, lymph node status, tumour grade and type of treatment. These same variables were considered as having prognostic significance within the Cox model analysis. Nevertheless, the predictions made by the NN were statistically significant more accurate than those from the Cox model (p < 0.0001). Seven different time intervals were also analyzed to find that the NN predictions were much more accurate than those from the Cox model in particular in the early intervals between 1-10 and 11-20 months, and in the later one considered from 61 months to maximum follow-up time (MFT). Interestingly, these intervals contain regions of high relapse risk that have been observed in different studies and that are also present in the analyzed dataset.

Punción biopsia de una lesión mamaria dirigida por tomografía computarizada / Computed tomography directed biopsy of a breast lesion

La localización y biopsia de lesiones no palpables de mama, mediante técnicas de imagen, son prácticas frecuentes. La técnica de elección es la mamografía. En circunstancias muy particulares, como lesiones difíciles de visualizar por mamografía, se puede utilizar la tomografía computarizada (TC)1,2. Con la reciente introducción de la resonancia magnética (RM) para la evaluación diagnóstica de la mama, se ha incrementado la posibilidad de detectar lesiones que no pueden visualizarse por mamografía o ultrasonografía. Se han descrito procedimientos para posicionar la aguja en estas lesiones mamarias, usando como guía la propia RM4-10 o la TC11. Queremos presentar el caso de una paciente con una lesión mamaria sospechosa de malignidad en la que, por sus características especiales, tuvimos que realizar una punción biopsia de la misma guiada por TC (AU)