The TEOGIC study project: a comprehensive characterization of early onset gastrointestinal cancer in the Northern area of Spain.

BACKGROUND: Gastrointestinal cancers represent one of the most prevalent diseases worldwide. Strikingly, the incidence of Early Onset Gastrointestinal Cancer (EOGIC) has been rising during the last decades and changes in lifestyle and environmental exposure seem to play a role. EOGIC has been defined as a different entity compared to on-average gastrointestinal cancer, with distinct clinical and molecular characteristics. Inherent to the particularities of younger age, there is an unmet need for a tailored approach for the management of these patients. The TEOGIC proposes a comprehensive study to characterize EOGIC patients in the northern of Spain. METHODS: Patients with histologically confirmed new diagnosis of colorectal, gastroesophageal and pancreatic adenocarcinoma will be considered for two cohorts: EOGIC (≤ 50 years old) and non-EOGIC (60-75 years old), with a ratio of 1:2. Two hundred and forty patients will be recruited in 4 Public Hospitals from northern Spain. After receiving unified informed consent, demographic and clinical data of the patients will be collected in a REDCap database. Lifestyle related data will be obtained in questionnaires assessing diet, physical activity and the general quality of life of the patients before diagnosis. Biological samples prior to any onco-specific treatment will be obtained for the analyses of circulating inflammatory proteins, gut microbiota, and the proteome of the tumor microenvironment. Histologic characteristics and routine biomarkers will be also collected. Thereafter, data will be integrated and analyzed to assess tumor specific, pan-tumor and sex-associated differential characteristics of EOGIC. DISCUSSION: The underlying risk factors and differential characteristics of EOGIC remain poorly studied, particularly in our geographical area. Although limited by the exploratory nature and the small sample size estimated to be recruited, TEOGIC represents the first attempt to comprehensively characterize these young patients, and thus attend to their special needs. Findings derived from this study could contribute to raise awareness and preventive behaviors in the population. In parallel, molecular studies could lead to the identification of potential novel non-invasive biomarkers and therapeutic targets that would help in the development of the tailored clinical management of these patients, focusing on screening programs for early diagnosis and precision medicine.

[Utility of the AGREE tool for the development and evaluation of clinical protocols: From theory to clinical practice]. / Utilidad del instrumento AGREE para la elaboración y la evaluación de protocolos clínicos: de la teoría a la práctica clínica.

INTRODUCTION AND OBJECTIVE: Clinical protocols are tools for the delivery of optimal and quality healthcare. However, there are often shortcomings in the quality of their design that invalidate their implementation. The aim of this study is to describe a systematic evaluation of clinical protocols, to analyse their quality in order to enable their implementation. MATERIALS AND METHODS: Descriptive study that included the clinical protocols assessed by the Committee of Reviewers of Clinical Practice Recommendations and Health Technologies of a tertiary hospital during 11years of its existence between 2013 and 2023. The AGREE instrument was used to assess the quality of the protocols received, calculating standardised scores by item and domain, and categorising them into: a)excellent (90-100%), b)good (70-89%), c)improvable (50-69%), d)very improvable (30-49%), e)deficient (10-29%), and f)very deficient: 0-9%. RESULTS: Of the 59 documents received by the Commission, 32 were subsidised for AGREE evaluation. The highest scoring domain was «Scope and objective¼, with excellent scores for 29 protocols; the remaining domains had scores ranging from 58.5%-100% for «Rigour in elaboration¼ and 0-100% for «Independence¼. By items, scores ranged from 85.7-100% for «Target users of the protocol are clearly defined¼ to 0-100% for the items «Potential costs of implementing recommendations¼ and «Conflict of interest¼. Of the 32 protocols, 9 were highly recommended, 22 were recommended with modifications/conditions and one was not recommended. CONCLUSIONS: The AGREE tool makes it possible to systematize both the drafting of clinical protocols by the authors and their evaluation by the Clinical Practice Recommendations and Health Technologies Review Committee. This makes it possible to have applicable and quality protocols in our hospital, which results in an improvement in the quality of healthcare.

Assessment of the main factors affecting the dynamics of nutrients in two rainfed cereal watersheds.

Nutrient dynamics and factors that control nutrient exports were observed in two watersheds, namely Latxaga and La Tejería, with similar climatic and management characteristics throughout 10 years (2007-2016). Similar patterns were observed in intra-annual and inter-annual dynamics with higher NO3- concentration and NO3--N yield during the humid seasons (i.e., winters and hydrological year 2013). Regarding concentration, Latxaga showed a higher decrease of nitrate due to a higher development of vegetated areas. High discharge events produced nitrate dilution due to the presence of tile-drainage at La Tejeria. At Latxaga, where tile-drainage was not observed, an increase in concentration occurred as a response to high discharge events. Comparing both watersheds, La Tejería presented ca. 73 ±â€¯25 mg NO3- L-1 while at Latxaga, the concentration observed was almost three times lower, with ca. 21 ±â€¯15 mg NO3- L-1 throughout the study period. Similar patterns were observed for the NO3--N yield, with 32 kg NO3--N ha-1 year-1 and 17 kg NO3--N ha-1 year-1 at La Tejería and Latxaga, respectively. Regarding phosphorous, the observed concentrations were 0.20 ±â€¯0.72 mg PO43- L-1 and 0.06 ±â€¯0.38 mg PO43- L-1 at La Tejería and Latxaga, respectively, with PO43--P yields being 71 kg PO43--P ha-1 year-1 and 33 kg PO43--P ha-1 year-1. Annual phosphate-P yield distribution in both watersheds followed similar patterns to those observed for the nitrate-N yield, with higher yields in the humid season. Regarding concentration, highly erosive rainfall that occurred in summer, mobilizing sediments and probably generating desorption of phosphorous in the stream channel, increased phosphate concentration. This research adds to the knowledge base regarding the dynamics of nutrients and the controlling factors in complex agricultural systems with Mediterranean characteristics.

[Characteristics of YouTube videos in Spanish about the influenza vaccine]. / Características de los vídeos de YouTube en castellano sobre la vacuna antigripal.

BACKGROUND: To analyze the characteristics of YouTube videos in Spanish about the influenza vaccine. METHODS: In April 2019, a search was conducted on YouTube with the term vacuna gripe. We studied the association between the type of author, and country of publication, and the rest of the variables (tone of the message, type of publication, and vaccination recommendations according to the Spanish Ministry of Health, among others) with univariate analysis and a multiple logistic regression model. RESULTS: In total, 208 videos were assessed; 51.0% had been published from Spain and Mexico, and 79.8% of the videos supported the use of influenza vaccines. The main topics discussed in the videos were whether the vaccine should be considered the most effective method to prevent influenza (64.4%) and recommendations concerning the vaccination of people over 65 years old (43.3%). The variables type of authorship (healthcare professionals) and country of publication (Spain) were associated with a positive attitude towards vaccination (OR: 2.91; 95%CI: 1.12-7.53 and OR: 0.31; 95%CI: 0.15-0.65, respectively). CONCLUSIONS: The existing information on YouTube about the influenza vaccine is not generally very complete, and it varies depending on the authorship of the videos and the country of publication. It would be advisable for healthcare professionals to publish videos promoting vaccination based on the guidelines from the Spanish Ministry of Health, and it is necessary to promote those videos for Spanish users who search for reliable information about this vaccine on YouTube.

Irrigation implementation promotes increases in salinity and nitrate concentration in the lower reaches of the Cidacos River (Navarre, Spain).

The shift from rainfed to irrigated agriculture is associated with a change in the fertilization rates due to increases in expected production and the fact of growing more N demanding crops. In addition, the circulation of irrigation return flows (IRF) mobilizes soluble salts stored in soils or geological materials. As a consequence, it implies severe modifications in the dynamics and total amount of soluble salts and nitrogen exported, especially in semi-arid watersheds. In this study, long-term data collected by the regional authorities was used to assess the effects of irrigation implementation on salinity (using electrical conductivity, EC, as a proxy) and nitrate concentration (NO3-) after the transformation of ca. 77 km2 from rainfed to irrigated agriculture in the Cidacos River (CR) watershed. The results indicate that water quality in the lower reaches of the CR was significantly modified after the diffuse incorporation of IRF. In contrast, neither EC nor NO3- were different in those monitoring stations whose contributing watersheds did not include transformed area. In addition, the temporal dynamics in the analysed variables shifted from a rainfed land signal typical in the region to an irrigated land signal, and the hydrochemical type of the CR shifted from mixed-to-Na+-mixed-to-HCO3- to mostly Na+-mixed type, typical of waters affected by IRF in the region. Groundwater EC and NO3- also increased in those wells located within the irrigated area. Although there are great uncertainties in the actual amount of salt and N reaching the CR via IRF, the expected contribution of waste water spilled into the CR is minor in comparison to other sources, mostly agricultural sources in the case of N. The observed changes have promoted the designation of the lower reaches of the CR as "affected" by NO3- pollution, and the whole CR watershed as a Nitrate Vulnerable Zone, with the emergent question about whether irrigation implementation as carried out currently in Spain is against the environmental objectives of the Water Framework Directive.

Intubación orotraqueal a través de mascarilla laríngea Ambu(R) Auragain(TM) en paciente pediátrico con lipomatosis infiltrante congénita / Endotracheal intubation through laryngeal Ambu(R) Auragain(TM) mask airway mask in paediatric patients affected by congenital infiltrating lipomatosis

Las malformaciones congénitas que afectan a la vía aérea pueden generar problemas para realizar una ventilación efectiva, intubación o incluso ambas, con el consiguiente aumento del riesgo de hipoxemia. Es esencial para el anestesiólogo pediátrico el conocimiento exacto de la anatomía de la vía aérea del paciente, así como una planificación preoperatoria cuidadosa. Cada vez son más los dispositivos diseñados para el control de la vía aérea en el paciente pediátrico. Este caso clínico describe el uso de la mascarilla laríngea de tercera generación (Ambu(R) Auragain(TM)) para la intubación orotraqueal de un paciente pediátrico con vía aérea difícil prevista secundaria a lipomatosis infiltrante congénita en la región facial

Congenital defects that affect paediatric airway could lead to several difficulties for effective ventilation, intubation, or even both, increasing the risk of hypoxaemia. It is essential for the paediatric anaesthesiologist to have accurate knowledge of the anatomy of patient́s airway, as well as judicious preoperative planning. Increasingly, more devices have been designed for the control of difficult airway in the paediatric patient. This case report describes the application of a third-generation laryngeal mask (- Ambu(R) Auragain (TM)) for endotracheal intubation of a child with anticipated difficult airway, secondary to congenital diffuse infiltrating facial lipomatosis

Endotracheal intubation through laryngeal Ambu® Auragain™ mask airway mask in paediatric patients affected by congenital infiltrating lipomatosis. / Intubación orotraqueal a través de mascarilla laríngea Ambu® Auragain™ en paciente pediátrico con lipomatosis infiltrante congénita.

Congenital defects that affect paediatric airway could lead to several difficulties for effective ventilation, intubation, or even both, increasing the risk of hypoxaemia. It is essential for the paediatric anaesthesiologist to have accurate knowledge of the anatomy of patient́s airway, as well as judicious preoperative planning. Increasingly, more devices have been designed for the control of difficult airway in the paediatric patient. This case report describes the application of a third-generation laryngeal mask (- Ambu® Auragain ™) for endotracheal intubation of a child with anticipated difficult airway, secondary to congenital diffuse infiltrating facial lipomatosis.

[Absenteeism and associated factors in scheduled visits to a Preventive Medicine outpatient clinic]. / Absentismo, y factores asociados, en las citas programadas de una consulta externa de Medicina Preventiva.

BACKGROUND: Patient absenteeism in outpatient clinics represents a significant obstacle to the cost-effectiveness of healthcare. The aim of this study was to assess the frequency of absence of patients and its associated factors in scheduled visits to a Preventive Medicine department. PATIENTS AND METHODS: The cross-sectional study was carried out in the Service of Preventive Medicine of the Lozano Blesa University Clinical Hospital of Zaragoza. It included all the visits scheduled from 3 January to 31 March 2017. For each visit, the date and time were registered, together with the type (first or consecutive appointments), age, gender, town of residence, country of birth, and underlying disease. The Chi-squared test was used to determine the association between the variables and making the visit, with a multiple logistic regression analysis being performed on the variables in which a significant association was found. RESULTS: Of the total of 582 appointments studied, the absenteeism rate was 12.5% (73 out of 582; 13.7% for first appointments and 11.7% for consecutive appointments). Variables that revealed a significant association with patients not attending were: time (9.00-11:15 a. m.; OR=1.84; 95%CI: 1.10-3.08), day of the week (Mondays-Thursdays; OR=3.19; 95%CI: 1.12-9.07), country of birth (outside of Spain; OR=2.09; 95%CI:1.09-3.99), vaccination group (chronic kidney disease during pre-dialysis or dialysis; OR=3.59; 95%CI: 1.57-8.18), and age group (under 52 years old; OR=1.85; 95%CI: 1.08-3.19). CONCLUSIONS: The rate of absenteeism is at an intermediate position compared to the outpatient visits for other departments. The detection of associated factors makes it possible to plan specific measures for improvements that may reduce absences.

Efectividad de una intervención para mejorar la calidad de la cumplimentación del listado de verificación de seguridad quirúrgica en un servicio de cirugía general / Effectiveness of an intervention to improve the quality of compliance with the surgical safety checklist in the operations performed by a general surgery department

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Propuesta de tarjeta triaje en incidentes NBQ con múltiples heridos / Proposal of Triage Tag in NBQ Multi-Casualty Incidents

INTRODUCCIÓN: La amenaza por un incidente nuclear, químico o biológico (NBQ) es una preocupación que aumenta progresivamente en nuestra sociedad actual. El porcentaje de heridos en este tipo de sucesos puede ser potencialmente muy elevada. El triaje de éstos debe estar bien estructurado y adaptado a las distintas áreas de zonificación. OBJETIVO: El principal objetivo es presentar dos nuevas herramientas de diseño propio que sirvan para realizar el triaje de los heridos en escenarios NBQ con múltiples heridos. La primera de ellas es la «tarjeta triaje NBQZC» y está diseñada para su utilización en la zona contaminada. La segunda es la «tarjeta triaje NBQZNC», la cual se emplea en la zona no contaminada. Ambas están creadas para su utilización en zona de operaciones, siendo fáciles de interpretar y de cumplimentar. CONCLUSIONES: Se exponen dos tarjetas de triaje de heridos NBQ de aplicación en el ámbito militar

INTRODUCTION: Nuclear, Chemical or Biological incident's threat is a concerning issue progressively increasing in our society. In these events injures' percentage potentially might be very high. Casualties' Triage has to be well structured and adapted to the different zoning areas. OBJECTIVE: The main goal is to introduce two new own design tools assisting in the performance of CBRN triage in a Major Incident. The first one is «Triage Tag NBCZC» and it is accomplished in the contaminate zone. The second one is «Triage Tag NBCNZC» and it is filled in the not contaminate area. Both of them are created to be executed in an Area of Operations and their interpretation and completion can be made easily. CONCLUSION: Two news Triage Tag CBRN casualties are showing available to a military scene

Evaluación de la información sanitaria disponible en internet sobre la vacuna antigripal / Evaluation of health information about the influenza vaccine on internet

Fundamento: La calidad de la información sanitaria en internet preocupa a gobiernos y usuarios. Nuestro objetivo fue determinar en qué medida la información sobre la vacuna antigripal se adhiere al gold estándar representado por lo establecido por el Ministerio de Sanidad español. Material y métodos: Entre junio-julio 2014 se evaluó la adhesión al gold estándar de la información sobre indicaciones, efectos adversos y contraindicaciones de la vacuna. Dicha información se obtuvo a través de Google, utilizando términos proporcionados por estudiantes de medicina. Se realizó un análisis univariante, donde variable resultado fue obtener información correctamente adherida, y variables explicativas fueron el tipo de origen de la información y su país. Resultados: Con los términos de 104 alumnos se obtuvieron 134 enlaces web diferentes. La adhesión alcanzó el 65,7% (88/134) en cuanto a la indicación en trabajadores sanitarios (TS). El 19,4% aportaron información incorrecta sobre indicación en embarazadas. La información de organismos oficiales de salud pública se adhirió significativamente mejor (indicación en TS (OR: 2,6), embarazadas (OR: 5,4) e inmunodeprimidos (OR: 2,2). La información de enlaces web españoles se adhirió peor (indicación en embarazo (OR: 0,3) y contraindicación si alergia al huevo (OR: 0,5). Conclusiones: El nivel de adhesión detectado fue mejorable. Se debe urgir y promocionar en los usuarios la utilización de las páginas web de organismos oficiales de salud pública cuando busquen información sobre la vacuna antigripal en internet (AU)

Background: The quality of health information on internet is a question of concern to governments and users. Our aim was to determine the extent to which information about the influenza vaccine adheres to the gold standard set by the Spanish Health Ministry. Methods: Between June and July 2014 information on indications, adverse effects and counter-indications of the vaccine was evaluated to see if it adhered to this gold standard. This information was obtained through Google, using terms provided by medical students. A univariate analysis was performed, where the variable result was getting information that adhered correctly to the standard, and explanatory variables were the type of origin of the information and its country. Results: Using the terms provided by 104 students, we obtained 134 different web links. Adhesion reached 65.7% (88/134) with respect to indication in health workers (HW). Nineteen point four percent provided incorrect information on indication in pregnant women. There was significantly better adherence in the information from official public health bodies (indication in HW (OR: 2.6), pregnant women (OR: 5.4) and immunodepressed patients (OR: 2.2). Adherence of information on Spanish web links was worse (indication in pregnancy (OR: 0.3) and counter-indication if allergic to eggs (OR: 0.5). Conclusions: Adhesion was improvable. It’s necessary to promote that internet users use official public health bodies websites when they search information regarding influenza vaccine on internet (AU)

Nab-paclitaxel: a flattering facelift.

The application of nanotechnology in oncology has increased the efficacy and efficiency of some cytotoxic agents. The paradigm in this field is nab-paclitaxel, a soluble form of paclitaxel that is linked to albumin nanoparticles. The development of nanotechnology as a delivery system for paclitaxel has provided better pharmacokinetic and pharmacodynamic characteristics, neutralizing its hydrophobicity. This procedure significantly improves the treatment of metastatic breast cancer compared to conventional paclitaxel-based therapies, including other type of cancers such as metastatic pancreatic cancer, stage IIIB-IV non-small cell lung cancer (NSCLC) and metastatic melanoma. In these last cases, significant differences were found in primary end-points for patients treated with nab-paclitaxel-based chemotherapy compared to those treated with conventional treatments. The application of nanotechnology in cancer treatment may also improve the efficacy of other known drugs, as a result of improved pharmacokinetic and pharmacodynamic profiles, similarly to paclitaxel.

Réplica: Telemedicina en atención primaria: cómo afecta a los profesionales sanitarios / Reply: Telemedicine in primary health care: How it affects professionals

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[Evaluation of health information about the influenza vaccine on internet]. / Evaluación de la información sanitaria disponible en Internet sobre la vacuna antigripal.

BACKGROUND: The quality of health information on internet is a question of concern to governments and users. Our aim was to determine the extent to which information about the influenza vaccine adheres to the gold standard set by the Spanish Health Ministry. METHODS: Between June and July 2014 information on indications, adverse effects and counter-indications of the vaccine was evaluated to see if it adhered to this gold standard. This information was obtained through Google, using terms provided by medical students. A univariate analysis was performed, where the variable result was getting information that adhered correctly to the standard, and explanatory variables were the type of origin of the information and its country. RESULTS: Using the terms provided by 104 students, we obtained 134 different web links. Adhesion reached 65.7% (88/134) with respect to indication in health workers (HW). Nineteen point four percent provided incorrect information on indication in pregnant women. There was significantly better adherence in the information from official public health bodies (indication in HW (OR: 2.6), pregnant women (OR: 5.4) and immunodepressed patients (OR: 2.2)). Adherence of information on Spanish web links was worse (indication in pregnancy (OR: 0.3) and counter-indication if allergic to eggs (OR: 0.5). CONCLUSIONS: Adhesion was improvable. It's necessary to promote that internet users use official public health bodies websites when they search information regarding influenza vaccine on internet.

Influencia de las unidades de corta estancia en la calidad de la atención hospitalaria en España. Revisión sistemática / Impact of short-stay units on the quality of medical care in Spain

Objetivo. Las unidades de corta estancia (UCE) se han desarrollado como alternativa a la hospitalización convencional. El objetivo de este estudio es analizar la influencia de las UCE creadas en España sobre la calidad asistencial. Material y métodos. Se realizó una revisión sistemática de la literatura en Medline e Índice Médico Español para identificar estudios que evaluaran los resultados de la implantación de las UCE de nuestro país, en términos de efectividad clínica, eficiencia y satisfacción de pacientes y se revisaron las referencias de los artículos hallados. Se extrajeron datos relativos a estancia media y tasas de mortalidad y de reingreso, entre otros. Resultados. Se encontraron 27 artículos con una importante heterogeneidad tanto en el tipo de UCE evaluada como en el propio diseño de los estudios. Tras comparar los resultados se observó que las UCE proporcionan cuidados asistenciales con efectividad. Además, se encontró evidencia de calidad baja que apoya que las UCE reducen la estancia media en el conjunto del hospital o del servicio considerado, sin encontrar evidencias que supongan otros beneficios al compararlas con otro tipo de unidades de hospitalización. Conclusiones. Las UCE pueden ayudar a mejorar la efectividad de la asistencia sanitaria en pacientes seleccionados, así como a reducir la estancia media hospitalaria, aunque es preciso realizar nuevas investigaciones para definir su papel y su modelo óptimo de funcionamiento(AU)

Objective. Short-stay units (SSUs) have been developed as an alternative to conventional hospitalisation. The aim of this study is to analyse the impact of short-stay units on the quality of medical care in Spain. Material and methods. A systematic review was performed by retrieving studies that analysed the results of SSUs in Spain, in terms of clinical effectiveness, efficiency and satisfaction among patients, using an electronic database search (Pubmed/Medline and Spanish Medical Index) and a review of selected references. The data collected included, mortality, length of stay and re-admission rates, as well as other variables. Results. Twenty-seven articles were found, with a great heterogeneity in both study design and type of SSU analysed. After analysing results, it was observed that SSUs in Spain provided effective clinical care. Low-quality evidence was also found supporting the hypothesis that SSUs are able to reduce overall length of stay in the whole hospital or department where they were created. There are not enough data to support any other advantages or benefits of SSUs, when compared with other hospitalisation units. Conclusions. SSUs may be able to effectively improve clinical care in selected patients, and may help to shorten overall length of stay. Further research is needed in order to define their exact role and to establish their optimal model(AU)

[Impact of short-stay units on the quality of medical care in Spain]. / Influencia de las unidades de corta estancia en la calidad de la atención hospitalaria en España. Revisión sistemática.

OBJECTIVE: Short-stay units (SSUs) have been developed as an alternative to conventional hospitalisation. The aim of this study is to analyse the impact of short-stay units on the quality of medical care in Spain. MATERIAL AND METHODS: A systematic review was performed by retrieving studies that analysed the results of SSUs in Spain, in terms of clinical effectiveness, efficiency and satisfaction among patients, using an electronic database search (Pubmed/Medline and Spanish Medical Index) and a review of selected references. The data collected included, mortality, length of stay and re-admission rates, as well as other variables. RESULTS: Twenty-seven articles were found, with a great heterogeneity in both study design and type of SSU analysed. After analysing results, it was observed that SSUs in Spain provided effective clinical care. Low-quality evidence was also found supporting the hypothesis that SSUs are able to reduce overall length of stay in the whole hospital or department where they were created. There are not enough data to support any other advantages or benefits of SSUs, when compared with other hospitalisation units. CONCLUSIONS: SSUs may be able to effectively improve clinical care in selected patients, and may help to shorten overall length of stay. Further research is needed in order to define their exact role and to establish their optimal model.