The relationship between physician and cancer patient when initiating adjuvant treatment and its association with sociodemographic and clinical variables

Purpose: The aim of this study was to analyze differences in physician and patient satisfaction in shared decision-making (SDM); patients’ emotional distress, and coping in subjects with resected, non-metastatic cancer. Methods: 602 patients from 14 hospitals in Spain were surveyed. Information was collected regarding physician and patient satisfaction with SDM, participants’ emotional distress and coping, as well as patient sociodemographic and clinical characteristics by means of specific, validated questionnaires. Results: Overall, 11% of physicians and 19% of patients were dissatisfied with SDM; 22% of patients presented hopelessness or anxious preoccupation as coping strategies, and 56% presented emotional distress. By gender, female patients showed a higher prevalence of dissatisfaction with SDM (23 vs 14%), anxious preoccupation (26 vs 17%), and emotional distress (63 vs 44%) than males. Hopelessness was more prevalent in individuals with stage III disease than those with stages I-II (28 vs 18%). Conclusion: Physicians must be mindful of the importance of emotional support and individual characteristics when communicating treatment options, benefits, and adverse effects of each alternative to oncological patients

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Validation of SDM-Q-Doc Questionnaire to measure shared decision-making physician’s perspective in oncology practice

Objective. The aim of this study was to analyze the psychometric properties of the Shared Decision-Making Questionnaire–Physician version (SDM-Q-Doc) in a sample of medical oncologists who provide adjuvant treatment to patients with non-metastatic resected cancer and the correlations between the total SDM-Q-Doc score and physician satisfaction with the information provided. Methods. Prospective, observational and multicenter study in which 32 medical oncologists and 520 patients were recruited. The psychometric properties, dimensionality, and factor structure of the SDM-Q-Doc were assessed. Results. Exploratory factor analyses suggested that the most likely solution was two-dimensional, with two correlated factors: one factor regarding information and another one about treatment. Confirmatory factor analysis based on cross-validation showed that the fitted two-dimensional solution provided the best fit to the data. Reliability analyses revealed good accuracy for the derived scores, both total and sub-scale, with estimates ranging from 0.81 to 0.89. The results revealed significant correlations between the total SDM-Q-Doc score and physician satisfaction with the information provided (p < 0.01); between information sub-scale scores (factor 1) and satisfaction (p < 0.01), and between treatment sub-scale scores (factor 2) and satisfaction (p < 0.01). Medical oncologists of older age and those with more years of experience showed more interest in the patient preferences (p = 0.026 and p = 0.020, respectively). Patient age negatively correlated with SDM information (p < 0.01) and physicians appear to provide more information to young patients. Conclusion. SDM-Q-Doc showed good psychometric properties and could be a helpful tool that examines physician’s perspective of SDM and as an indicator of quality and satisfaction in patients with cancer (AU)

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Réplica. Esclerosis múltiple y neurocisticercosis / Reply. Multiple sclerosis and neurocysticercosis

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Neurotoxicidad por aciclovir frente a encefalitis por varicela zoster en un paciente con insuficiencia renal crónica / Acyclovir neurotoxicity vs. encephalitis due to varicella zoster in a patient with chronic renal failure

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Esclerosis múltiple y neurocisticercosis. Dilema diagnóstico / Multiple sclerosis and neurocysticercosis: a diagnostic dilemma

Introducción. La esclerosis múltiple (EM) y la neurocisticercosis (NC) son dos entidades cuyas manifestaciones clínicas, hallazgos en neuroimagen y estudios inmunológicos y serológicos no son patognomónicos ni específicos, y una buena historia clínica y un buen seguimiento son fundamentales para el diagnóstico. Casos clínicos. Se trata de dos casos que consultaron por síntomas neurológicos focales, con el hallazgo en la neuroimagen de múltiples lesiones, algunas de ellas captadoras de contraste; se diagnosticó por ello, apoyado en uno de los casos por serología positi va para cisticerco, de NC, y se instauró un tratamiento antiparasitario. Con la evolución clínica, una historia clínica dirigida y sobre la base de los criterios diagnósticos propuestos por McDonald para la EM y por Del Brutto para la NC, se diagnosticaron de EM. Conclusiones. El primer escalón para llegar al diagnóstico de EM es plantearse esa posibilidad. El diagnóstico es todavía fundamentalmente clínico y precisa que se demuestre diseminación de síntomas, o cambios en la neuroimagen, tanto en el espacio como en el tiempo. Es preciso establecer el diagnóstico diferencial con otras entidades que comparten similitudes en la clínica, la neuroimagen y los hallazgos del LCR. Aun con los últimos criterios propuestos para el diagnóstico de EM y NC, pueden plantearse dudas que obligan a una interpretación cautelosa de la clínica y los resultados de los estudios (AU)

Introduction. Both multiple sclerosis (MS) and neurocysticercosis (NC) are two entities in which clinical manifestations, neuroimaging findings and immunoserologic assays are neither pathognomonic nor specific requiring for their diagnosis an accurate examination of the clinical history of patients and an adequate follow-up. Case reports. Two patients who consulted non neurologists about focal neurological symptoms. Neuroimaging findings revealed multiple lesions, some of them contrast-enhanced. A diagnosis of neurocysticercosis was established, supported in one of the patients by positive serologic assays for cysticerci and antihelmintic therapy began to be administered. Observing the clinical evolution of the patients, monitoring their clinical history and considering the diagnostic criteria proposed by McDonald for MS and by Del Brutto for NC the patients were finally diagnosed of MS. Conclusion. The first step to reach a diagnosis of MS is to consider such a possibility. The diagnosis is mainly based on clinical grounds and it is necessary to prove that symptoms disseminate or that alterations occur in neuroimaging findings both in time and space. It is of the utmost importance to establish a differential diagnosis with other conditions presenting with similar clinical manifestations, neuroimaging findings and cerebrospinal fluid tests results. Even with the latest criteria proposed for the diagnosis of MS and NC we may have doubts making it fundamental to cautiously interpret the clinical manifestations and tests results (AU)