A New Hierarchy of Research Evidence for Tumor Pathology: A Delphi Study to Define Levels of Evidence in Tumor Pathology.

The hierarchy of evidence is a fundamental concept in evidence-based medicine, but existing models can be challenging to apply in laboratory-based health care disciplines, such as pathology, where the types of evidence and contexts are significantly different from interventional medicine. This project aimed to define a comprehensive and complementary framework of new levels of evidence for evaluating research in tumor pathology-introducing a novel Hierarchy of Research Evidence for Tumor Pathology collaboratively designed by pathologists with help from epidemiologists, public health professionals, oncologists, and scientists, specifically tailored for use by pathologists-and to aid in the production of the World Health Organization Classification of Tumors (WCT) evidence gap maps. To achieve this, we adopted a modified Delphi approach, encompassing iterative online surveys, expert oversight, and external peer review, to establish the criteria for evidence in tumor pathology, determine the optimal structure for the new hierarchy, and ascertain the levels of confidence for each type of evidence. Over a span of 4 months and 3 survey rounds, we collected 1104 survey responses, culminating in a 3-day hybrid meeting in 2023, where a new hierarchy was unanimously agreed upon. The hierarchy is organized into 5 research theme groupings closely aligned with the subheadings of the WCT, and it consists of 5 levels of evidence-level P1 representing evidence types that merit the greatest level of confidence and level P5 reflecting the greatest risk of bias. For the first time, an international collaboration of pathology experts, supported by the International Agency for Research on Cancer, has successfully united to establish a standardized approach for evaluating evidence in tumor pathology. We intend to implement this novel Hierarchy of Research Evidence for Tumor Pathology to map the available evidence, thereby enriching and informing the WCT effectively.

Spatial analysis for risk assessment of dengue in Spain.

INTRODUCTION: The establishment of Aedes albopictus in new areas in Europe has changed the risk of local dengue transmission represented by imported human cases. The risk of transmission is determined by the distribution of travelers arriving from dengue-endemic areas and the distribution of Ae. albopictus as potential vectors of dengue in Spain. METHODS: Environmental, entomological, epidemiological, demographic, tourism and travel data were analyzed to produce a series of maps to represent: the distribution of Ae. albopictus across municipalities; the risk of expansion of Ae. albopictus based on a species distribution model; the calculated index of travelers from dengue-endemic areas (IDVZE) per province; the percentage contribution of each municipality to the total number of cases in Spain. The maps were then added using map algebra, to profile the spatial risk of autochthonous dengue in Spain at a municipal level from 2016 to 2018. RESULTS: Ae. albopictus was detected in 983 municipalities. The calculated IDVZE varied from 0.23 to 10.38, with the highest IDVZE observed in Madrid. The overall risk of autochthonous cases oscillated between 0.234 and 115, with the very high risk and high risk areas detected in the Mediterranean region, mainly in the Levantine coast and some parts of the Balearic Islands. Most of the interior of the peninsula was characterized as low risk. CONCLUSION: Prevention and control measures to mitigate the risk of autochthonous dengue should be prioritized for municipalities in the high risk areas integrating early detection of imported dengue cases and vector control.

What is essential remains invisible to the eyes? Blood pressure cuffs colonized by bacterial diversity.

Using sphygmomanometers to measure blood pressure is a common practice in the healthcare context. The disinfection and maintenance of these devices is essential in clinical practice to prevent the proliferation of microorganisms. The aim of this study was to determine the presence of pathogenic microorganisms in sphygmomanometer cuffs in the clinical setting. A cross-sectional study was carried out. Five types of healthcare centers, selected through convenience sampling, participated in this study. Samples were collected from the inside of sphygmomanometer cuffs, and labeled and delivered to the laboratory for analysis. The samples were incubated in an oven at 35.5 °C for 24 h. A total CFU count was carried out on the plates that were cataloged as positive. Colonies that showed growth were identified using the matrix-assisted laser desorption/ionization-mass spectrometry technology. Of the total sample, (N = 372), 69.1% were positive and were isolated. In 30.9% (n = 115), no bacterial development was found within 48 h. A total of 257 microorganisms were found. The mean number of colony-forming units was 29.62 (SD = 32.33). The socio-health centers had the highest amount of bacterial contamination in the cuffs. In regards to the type of microorganisms, 31.5% (n = 81) found were Bacillus cereus, followed by 26.8% (n = 69) of Staphylococcus hominis and 9.7% (n = 25) were Pantoea agglomerans, among others. Statistically significant differences were found between the type of microorganism and the hours elapsed since the last disinfection (X2(19) = 44.582; p = 0.001). Statistically significant differences were found between the time elapsed since the last disinfection and the type of sphygmomanometer (X2 (2) = 117.752; p = 0.000). Despite the fact that most hospitals and health centers have established infection control policies and protocols, the results of this study indicate the presence of pathogenic microorganisms in blood pressure cuffs in the clinical setting.

Phyllodes tumour evidence gaps mapped from the 5th edition of the WHO classification of tumours of the breast.

AIMS: Breast phyllodes tumours (PTs) are a rare subset of fibroepithelial neoplasms categorised into benign, borderline, and malignant grades according to the World Health Organization (WHO) Classification of Tumours (WCTs). In this report, we developed an evidence gap map (EGM) based on the literature cited in the PT chapter of the 5th edition of the breast WCT in order to identify knowledge and research gaps in PT. METHODS: A framework was first established where the dimensions of the EGM were defined as categories of tumour descriptors, tumour types, and evidence levels. Citations were collected into a Microsoft Excel form and imported into EPPI-reviewer to produce the EGM. RESULTS: The EGM showed that the "Histopathology" and "Pathogenesis" sections contained the most citations, the majority being of low-level evidence. The highest number of citations considered of moderate-level evidence were found in the "Histopathology" section. There was no high-level evidence cited in this chapter. The "Localisation", "Aetiology", and "Staging" sections had the fewest citations. CONCLUSION: This EGM provides a visual representation of the cited literature in the PT chapter of the breast WCT, revealing the lack of high-level evidence citations. There is an uneven distribution of references, probably due to citation practices. Pockets of low-level evidence are highlighted, possibly related to referencing habits, lack of relevant research, or the belief that the information presented is standard accepted fact, without the need for specific citations. Future work needs to bridge evidence gaps and broaden citations beyond those in the latest WCT.

Respuesta de los autores: El papel clave de los equipos de emergencias extrahospitalarias en los programas de donación en asistolia no controlada en Andalucía / Authors' reply: Key role for out-of-hospital emergency teams in non-heart-beating donor programs in Andalusia

No disponible

Supervivencia y factores asociados a la práctica de reanimación cardiopulmonar en curso entre los pacientes con parada cardiaca extrahospitalaria / Ambulance cardiopulmonary resuscitation: outcomes and associated factors in out-of-hospital cardiac arrest

OBJETIVO: Conocer la supervivencia y los factores asociados a la realización de reanimación cardiopulmonar (RCP) en curso entre los pacientes con parada cardiaca extrahospitalaria (PCR). MÉTODO: Análisis retrospectivo de un registro de casos de PCR entre 2008 y 2014. Se incluyeron los pacientes con PCR sin recuperación espontánea de pulso en el momento de la toma de decisión del traslado hospitalario y que fueron desestimados para donación en asistolia. Se realizó un análisis multivariante para determinar las variables que se asociaron al uso de una estrategia de reanimación en curso y se determinó la supervivencia y el resultado neurológico en dicho grupo de casos. RESULTADOS: Se incluyeron 7.241 pacientes, de los cuales 259 (3,6%) fueron trasladados al hospital con RCP en curso. La edad media fue 51,6 (DE 23,6) años, de los cuales 27 (10,1%) casos tenían 16 años. Las variables que se asociaron con el uso de RCP en curso fueron: edad 16 años [OR 6,48 (IC95% 3,91-10,76); p < 0,001)], PCR presenciada [OR 1,62 (IC95% 1,16-2,26); p = 0,004], PCR ocurrida fuera del domicilio [OR 3,17 (IC95% 2,38-4,21); p < 0,001)]; etiología no cardiaca [OR 1,47 (IC95%1,07-2,02); p = 0,019], ritmo inicial desfibrilable [OR 1,67 (IC95% 1,17-2,37); p = 0,004], no existencia de soporte vital previo (SVp) [OR 3,48 (IC95% 2,58-4,70); p < 0,001] y realización de intubación orotraqueal (IOT) [OR 1,93 (IC95% 1,24-2,99); p = 0,003]. Un paciente (0,38%) sobrevivió al alta con buen estado neurológico. CONCLUSIONES: La RCP en curso en servicios de emergencias con médico a bordo es una estrategia poco frecuente en casos de PCR. La juventud del paciente, que la PCR suceda fuera del domicilio, sea presenciada, no exista soporte vital previo, tenga un ritmo inicial desfibrilable, una etiología no cardiaca y que se consiga IOT se asocian con esta estrategia cuyo resultado final puede considerarse fútil

OBJECTIVE: To assess factors associated with survival of out-of-hospital cardiac arrest (OHCA) in patients who underwent cardiopulmonary resuscitation (CPR) during ambulance transport. METHODS: Retrospective analysis of a registry of OHCA cases treated between 2008 and 2014. We included patients who had not recovered circulation at the time it was decided to transport to a hospital and who were rejected as non-heart-beating donors. Multivariate analysis was used to explore factors associated with the use of ambulance CPR, survival, and neurologic outcome. RESULTS: Out of a total of 7241 cases, 259 (3.6%) were given CPR during emergency transport. The mean (SD) age was 51.6 (23.6) years; 27 (10.1%) were aged 16 years or younger. The following variables were associated with the use of CPR during transport: age 16 years or under (odds ratio [OR], 6.48; 95% CI, 3.91-10.76); P

La valoración de la calidad de la resucitación cardiopulmonar con soporte telefónico realizada por testigos como elemento de evaluación del desempeño de un servicio de emergencias médicas / Quality assessment of bystander cardiopulmonary resuscitation during telephone assistance, a potential quality indicator of emergency medical service performance

No disponible

Ambulance cardiopulmonary resuscitation: outcomes and associated factors in out-of-hospital cardiac arrest. / Supervivencia y factores asociados a la práctica de reanimación cardiopulmonar en curso entre los pacientes con parada cardiaca extrahospitalaria.

OBJECTIVES: To assess factors associated with survival of out-of-hospital cardiac arrest (OHCA) in patients who underwent cardiopulmonary resuscitation (CPR) during ambulance transport. MATERIAL AND METHODS: Retrospective analysis of a registry of OHCA cases treated between 2008 and 2014. We included patients who had not recovered circulation at the time it was decided to transport to a hospital and who were rejected as non-heart-beating donors. Multivariate analysis was used to explore factors associated with the use of ambulance CPR, survival, and neurologic outcome. RESULTS: Out of a total of 7241 cases, 259 (3.6%) were given CPR during emergency transport. The mean (SD) age was 51.6 (23.6) years; 27 (10.1%) were aged 16 years or younger. The following variables were associated with the use of CPR during transport: age 16 years or under (odds ratio [OR], 6.48; 95% CI, 3.91-10.76); P<.001)], witnessed OHCA (OR, 1.62; 95% CI, 1.16-2.26; P=.004), cardiac arrest outside the home (OR, 3.17; 95% CI, 2.38-4.21; P<.001), noncardiac cause (OR, 1.47; 95% CI, 1.07-2.02; P=.019], initially shockable rhythm (OR, 1.67; 95% CI, 1.17-2.37; P=.004), no prior basic life support (OR, 3.48; 95% CI, 2.58-4.70; P<.001), and orotracheal intubation (OR, 1.93; 95% CI, 1.24-2.99; P=.003). One patient (0.38%) survived to discharge with good neurologic outcome. CONCLUSION: Ambulance CPR by a physician on board is applied in few OHCA cases. Young patient age, cardiac arrest outside the home, the presence of a witness, lack of a shockable rhythm on responder arrival, lack of basic life support prior to responder arrival, noncardiac cause, and orotracheal intubation are associated with the use of ambulance CPR, a strategy that can be considered futile.

OBJETIVO: Conocer la supervivencia y los factores asociados a la realización de reanimación cardiopulmonar (RCP) en curso entre los pacientes con parada cardiaca extrahospitalaria (PCR). METODO: Análisis retrospectivo de un registro de casos de PCR entre 2008 y 2014. Se incluyeron los pacientes con PCR sin recuperación espontánea de pulso en el momento de la toma de decisión del traslado hospitalario y que fueron desestimados para donación en asistolia. Se realizó un análisis multivariante para determinar las variables que se asociaron al uso de una estrategia de reanimación en curso y se determinó la supervivencia y el resultado neurológico en dicho grupo de casos. RESULTADOS: Se incluyeron 7.241 pacientes, de los cuales 259 (3,6%) fueron trasladados al hospital con RCP en curso. La edad media fue 51,6 (DE 23,6) años, de los cuales 27 (10,1%) casos tenían <= 16 años. Las variables que se asociaron con el uso de RCP en curso fueron: edad <= 16 años [OR 6,48 (IC95% 3,91-10,76); p < 0,001)], PCR presenciada [OR 1,62 (IC95% 1,16-2,26); p = 0,004], PCR ocurrida fuera del domicilio [OR 3,17 (IC95% 2,38-4,21); p < 0,001)]; etiología no cardiaca [OR 1,47 (IC95%1,07-2,02); p = 0,019], ritmo inicial desfibrilable [OR 1,67 (IC95% 1,17-2,37); p = 0,004], no existencia de soporte vital previo (SVp) [OR 3,48 (IC95% 2,58-4,70); p < 0,001] y realización de intubación orotraqueal (IOT) [OR 1,93 (IC95% 1,24-2,99); p = 0,003]. Un paciente (0,38%) sobrevivió al alta con buen estado neurológico. CONCLUSIONES: La RCP en curso en servicios de emergencias con médico a bordo es una estrategia poco frecuente en casos de PCR. La juventud del paciente, que la PCR suceda fuera del domicilio, sea presenciada, no exista soporte vital previo, tenga un ritmo inicial desfibrilable, una etiología no cardiaca y que se consiga IOT se asocian con esta estrategia cuyo resultado final puede considerarse fútil.

Estrategias de reperfusión en hospitales sin intervención coronaria percutánea primaria / Reperfusion strategies in hospitals without primary percutaneous coronary intervention

No disponible

Out-of-hospital cardiac arrest (OHCA) attended by mobile emergency teams with a physician on board. Results of the Spanish OHCA Registry (OSHCAR).

Most survival outcomes in out-of-hospital cardiac arrest (OHCA) are provided by emergency medical services (EMS) without a doctor on board. Our objective was to determine such outcomes in a whole country with public physician-led EMS. METHODS: We analyzed data from a nationwide prospective registry of OHCA cases attended by 19 public EMS in Spain, covering the period from 1-October 2013 to 30-October 2014. RESULTS: Advanced life support (ALS) was initiated in 9347 cases (incidence 18.6 cases/105 inhabitants per year). Resuscitation was considered futile in 558 cases (5.9%), and ALS was continued in 8789 cases (94.1%); mean age 63.5±17 years, 72.1% men. Initial rhythm was shockable in 22.1% of cases. Basic life support (BLS) was provided by bystanders in 1602 (24%) cases (635 of them with telephone assistance from the dispatch center). Of 8789 patients receiving ALS, 72.1% men, 2669 (30.4%) patients had return of spontaneous circulation on hospital arrival, 50.6% when the initial rhythm was shockable. Hospital discharge with good neurological status (CPC1-2) was found in 11.1% of the study population and in 27.6% when considering the Utstein comparator group of patients. A total of 216 (2.5%) patients arrived at the hospital with ongoing resuscitation, of whom only one survived with CPC1-2, and 165 (1.9%) patients were included in non-heart-beating donation programs. CONCLUSIONS: In Spain with physician-led EMS, OHCA survival with CPC1-2 reached a reasonable percentage despite only a modest contribution of bystander BLS. Ongoing resuscitation strategy seems to be futile except when considering non-heart beating donation programs.

Supervivencia y estado neurológico tras muerte súbita cardiaca extrahospitalaria. Resultados del Registro Andaluz de Parada Cardiorrespiratoria Extrahospitalaria / Survival and neurologic outcome after out-of-hospital cardiac arrest. Results of the andalusian out-of-hospital cardiopulmonary arrest registry

Introducción y objetivos: No hay demasiados datos sobre la muerte súbita prehospitalaria en España. El objetivo es describir su incidencia, las características de los pacientes y los resultados de su atención por un servicio de emergencias extrahospitalario. Métodos: Análisis retrospectivo de un registro prospectivo de parada cardiorrespiratoria atendida por un servicio de emergencias extrahospitalario entre enero de 2008 y diciembre de 2012. Se incluyó a todos los pacientes con estimación de etiología cardiaca como causa de la parada. Se realizó análisis descriptivo de las características generales de los pacientes y de los factores asociados con alta hospitalaria con buen estado neurológico. Resultados: Se incluyó a 4.072 pacientes, con una incidencia estimada de 14,6 eventos por 100.000 habitantes y año, el 72,6% varones. La media de edad era 62,0 ± 15,8 años. El 58,6% de los casos ocurrieron en domicilio. El 25% de los pacientes tenían un ritmo inicial desfibrilable. El 28,8% de los pacientes llegaron con pulso al hospital, el 58,3% del grupo con ritmo desfibrilable. El 10,2% recibió el alta en buen estado neurológico. Las variables asociadas con esta recuperación fueron: parada presenciada (p = 0,04), parada presenciada por el equipo de emergencias (p = 0,005), realización previa de soporte vital (p = 0,04), ritmo inicial desfibrilable (p = 0,0001) y realización de intervencionismo coronario (p = 0,0001). Conclusiones: Más de la mitad de los casos de muerte súbita ocurren en el domicilio. Afectan a una población relativamente joven. Aunque 1 de cada 10 pacientes tuvo una recuperación satisfactoria, la fase previa a la llegada de los equipos de emergencias debe mejorar. El intervencionismo coronario tuvo gran impacto en el pronóstico de los pacientes (AU)

Introduction and objectives: There is a paucity of data on prehospital cardiac arrest in Spain. Our aim was to describe the incidence, patient characteristics, and outcomes of out-of-hospital emergency care for this event. Methods: We conducted a retrospective analysis of a prospective registry of cardiopulmonary arrest handled by an out-of-hospital emergency service between January 2008 and December 2012. The registry included all patients considered to have a cardiac etiology as the cause of arrest, with a descriptive analysis performed of general patient characteristics and factors associated with good neurologic outcome at hospital discharge. Results: A total of 4072 patients were included, with an estimated incidence of 14.6 events per 100 000 inhabitants and year; 72.6% were men. The mean age was 62.0 ± 15.8 years, 58.6% of cases occurred in the home, 25% of patients had initial defibrillable rhythm, 28.8% of patients arrived with a pulse at the hospital (58.3% of the group with defibrillable rhythm), and 10.2% were discharged with good neurologic outcome. The variables associated with this recovery were: witnessed arrest (P = .04), arrest witnessed by emergency team (P = .005), previous life support (P = .04), initial defibrillable rhythm (P = .0001), and performance of a coronary interventional procedure (P = .0001). Conclusions: More than half the cases of sudden cardiac arrest occur at home, and the population was found to be relatively young. Although recovery was satisfactory in 1 out of every 10 patients, there is a need for improvement in the phase prior to emergency team arrival. Coronary interventional procedures had an impact on patient prognosis (AU)

Survival and Neurologic Outcome After Out-of-hospital Cardiac Arrest. Results of the Andalusian Out-of-hospital Cardiopulmonary Arrest Registry.

INTRODUCTION AND OBJECTIVES: There is a paucity of data on prehospital cardiac arrest in Spain. Our aim was to describe the incidence, patient characteristics, and outcomes of out-of-hospital emergency care for this event. METHODS: We conducted a retrospective analysis of a prospective registry of cardiopulmonary arrest handled by an out-of-hospital emergency service between January 2008 and December 2012. The registry included all patients considered to have a cardiac etiology as the cause of arrest, with a descriptive analysis performed of general patient characteristics and factors associated with good neurologic outcome at hospital discharge. RESULTS: A total of 4072 patients were included, with an estimated incidence of 14.6 events per 100000 inhabitants and year; 72.6% were men. The mean age was 62.0 ± 15.8 years, 58.6% of cases occurred in the home, 25% of patients had initial defibrillable rhythm, 28.8% of patients arrived with a pulse at the hospital (58.3% of the group with defibrillable rhythm), and 10.2% were discharged with good neurologic outcome. The variables associated with this recovery were: witnessed arrest (P=.04), arrest witnessed by emergency team (P=.005), previous life support (P=.04), initial defibrillable rhythm (P=.0001), and performance of a coronary interventional procedure (P=.0001). CONCLUSIONS: More than half the cases of sudden cardiac arrest occur at home, and the population was found to be relatively young. Although recovery was satisfactory in 1 out of every 10 patients, there is a need for improvement in the phase prior to emergency team arrival. Coronary interventional procedures had an impact on patient prognosis.

DIOCLES: Algunos matices y nuevas preguntas / DIOCLES: some caveats and new questions

No disponible

Initial complications and factors related to prehospital mortality in acute myocardial infarction with ST segment elevation.

OBJECTIVE: Hospital mortality in myocardial infarction ST-elevation myocardial infarction has decreased in recent years, in contrast to prehospital mortality. Our objective was to determine initial complications and factors related to prehospital mortality in patients with acute myocardial infarction with ST segment elevation (STEMI). METHODS: Observational study based on a prospective continuous register of patients of any age attended by out-of-hospital emergency teams in Andalusia between January 2006 and June 2009. This includes patients with acute coronary syndrome-like symptoms whose initial ECG showed ST elevation or presumably new left bundle branch block (LBBB). Epidemiological, prehospital data and final diagnostic were recorded. The study included all patients with STEMI on the register, without age restrictions. Forward stepwise logistic regression analysis was performed to control for confounders. RESULTS: A total of 2528 patients were included, 24% were women. Mean age 63.4±13.4 years; 16.7% presented atypical clinical symptoms. Initial complications: ventricular fibrillation (VF) 8.4%, severe bradycardia 5.8%, third-degree atrial-ventricular (AV) block 2.4% and hypotension 13.5%. Fifty-two (2.1%) patients died before reaching hospital. Factors associated with prehospital mortality were female sex (OR 2.36, CI 1.28 to 4.33), atypical clinical picture (OR 2.31, CI 1.21 to 4.41), hypotension (OR 4.95, CI 2.60 to 9.20), LBBB (OR 4.29, CI 1.71 to 10.74), extensive infarction (ST elevation in ≥5 leads) (OR 2.53, CI 1.28 to 5.01) and VF (OR 2.82, CI 1.38 to 5.78). CONCLUSIONS: A significant proportion of patients with STEMI present early complications in the prehospital setting, and some die before reaching hospital. Prehospital mortality was associated with female sex and atypical presentation, as pre-existing conditions, and hypotension, extensive infarction, LBBB and VF on emergency team attendance.

Desórdenes específicos de aprendizaje: una estrategia para su detección, diagnóstico y tratamiento / Specific disorders of the learning

Este trabajo describe el proceso que puede y debe ser empleado para un adecuado manejo en el caso del niño o adolescente que padezca un desorden específico de aprendizaje. La evaluación, el diagnóstico y el tratamiento especializado deben estar a cargo de un equipo interdisciplinario, y constituirse básicamente por el neurólogo, el especialista en lenguaje y aprendizaje y el psicólogo