Patch test informed consent form: position statement by European Academy of Dermatology and Venereology Task Force on Contact Dermatitis.

BACKGROUND: To our knowledge, an international consensus is lacking regarding the development of an adequate informed consent form for a patch test (PT) and the information that should be included in such document. OBJECTIVES: The aim of the study was to reach a consensus on the specific points that need to be addressed in a PT consent form. METHODS: A Delphi survey, comprising 2 rounds and 1 final discussion, was used to gather and analyse data, which was conducted over the Internet. Each statement that reached a consensus with the respondents (9 expert dermatologists from Europe) was defined as a median consensus score (MED) of ≥7 and agreement among panelists as an interquartile range (IQR) of ≤3. All study participants were members of the EADV task force on contact dermatitis. RESULTS: The expert panel addressed several topics that should be included in an informed consent form for a PT: introduction, preparation for PT, testing procedure, allowed activities, adverse events and additional authorizations. CONCLUSIONS: Our results assess recommendations regarding points to be contained in an informed consent form for a PR. Future actions towards standardization and harmonization of this specific consent form are needed.

Gender influence on work satisfaction and leadership for medical oncologists: a survey of the Spanish Society of Medical Oncology (SEOM).

BACKGROUND: Women represent an increasing proportion of the oncology workforce; however, globally this does not translate into leadership roles, reflecting disparities in career opportunities between men and women. The Spanish Society of Medical Oncology (SEOM) undertook a survey to investigate gender disparity in the Spanish oncology context. DESIGN: An online survey was made available to SEOM medical oncologists between February and May 2019. It included demographics, professional context and achievements, parenthood and family conciliation issues, workplace gender bias, and approaches to address disparities. RESULTS: Of the 316 eligible respondents, 71.5% were women, 59.5% were aged 45 or younger, and 66.1% had children. Among women, 12.4% were division or unit heads, compared with 45.5% of men, with most women (74.3%) being attending medical oncologists, compared with 45.5% of men. More males were professors (34.4% versus 14.2% of females), had a PhD (46.7% versus 28.8%), and/or had led clinical research groups (41.1% versus 9.7%). Spending time overseas after completing a residency was also more common for men than women (34.4% versus 20.4%). Professional satisfaction was similar between genders, driven primarily by patient care and intellectual stimulation. More women (40.7%) considered parenthood to have a strong negative impact on their career, compared with men (9.0%). Main perceived barriers to gender equality included a lack of work-life balance (72.6% women, 44.4% men), bias of peers and superiors (50.0% women, 18.9% men), and different career goals (41.2% women, 24.4% men). Preferred solutions included educational programs and scholarships (52.9%), communication and leadership training (35.8%), childcare at conferences (33.2%), and postmaternity return-to-work incentives (32.0%). CONCLUSION: There is a clear paucity of equal opportunities for female oncologists in Spain. This can be addressed by encouraging professional development and merit recognition particularly for younger female oncologists, and empowering women to be involved in management and leadership of institutions and professional societies.

Synthesis of La-Sr-Mn-O and La-Sr-Ca-Mn-O Perovskites Through Solution Combustion Using Urea at Fuel Deficient Conditions.

La0.7 Sr0.3 MnO3 (LSMO) nanoparticles have been obtained via solution combustion synthesis (SCS) using urea and glycine as fuels. Also, La0.7 Sr0.27 Ca0.03 MnO3 (LSCMO) nanoparticles have been synthesized through solution combustion using urea as fuel. In this paper, the combustion process was carried out with a fuel to oxidant ratio giving fuel deficient conditions ( ). The thermal analysis (TGA) indicate that the organic residues from the urea-nitrates gel mixture are eliminated above 600 °C and the post-synthesis heat treatment yields the formation of the desired phase without impurities. The obtained phases were analyzed using X-ray diffraction. The infrared analysis confirms the purity of the samples obtained using urea. However, the sample obtained using glycine confirms the formation of SrCO3. The morphology was analyzed using a FE-SEM microscope, and it was found that the particles present a spherical shape with a mean size of around 45 nm in the selected samples. The samples' energy dispersive X-ray spectra show that the desired elements (La, Sr, Ca, Mn and O) are present in the nanoparticles. The measured zero field cooled (ZFC) and field cooled (FC) magnetizations were recorded from 4.5 to 380 K at 105 A/m to obtain their blocking and Curie temperatures. Moreover, the hysteresis loops measured at room temperature confirm the superparamagnetic behavior of the elaborated samples. According to the results obtained, these nanoparticles have interesting properties that make them candidates to explore not only for their potential in biomedical applications but also in refrigeration and magnetic storage devices.

The role of the dermatologist in the immune-mediated/allergic diseases - position statement of the EADV task force on contact dermatitis, EADV task force on occupational skin diseases, UEMS-EBDV subcommission allergology and European Dermatology Forum.

BACKGROUND: The members of the Task Force on Contact Dermatitis and the Task Force on Occupational Dermatoses of the European Academy of Dermatology and Venereology (EADV), of the European Dermatology Forum (EDF), and the members of the UEMS Section of Dermatology-Venereology (UEMS-EBDV) we want to vindicate the fundamental role that the specialist in Dermatology has in the diagnosis and management of Immuno-mediated /allergic Diseases. OBJECTIVE: In disagreement with the blueprint paper of the UEMS section of Allergology (2013), in which dermatologists are excluded from one of their core activities it was decided to write this consensus paper. DISCUSSION: The skin occupies a crucial place in the broad spectrum of allergic diseases; there is no other organ with such a multitude of different clinical conditions mediated by so many pathogenetic immune mechanisms. Subsequently, dermatologists play a fundamental role in the management of immune-mediated diseases including among others contact dermatitis, atopic dermatitis, urticaria and angioedema or cutaneous adverse drug, food and arthropod reactions. The essential role of dermatology in the diagnostic, therapeutic and preventive management of immune mediated /allergic diseases which is crucial for patient management is justified from both the academic and professional point of view. CONCLUSION: Based on the best care of the patient with cutaneous immune allergic disease a multidisciplinary approach is desirable and the dermatologist has a pivotal role in patient management. Be so good and no one will not ignore you, dermatologist. Ideally Dermatology should be governed according the following Henry Ford statement: "Arriving together is the beginning; keeping together is progress; working together is success."

Relación miofuncional y tratamiento de ortodoncia en paciente con síndrome de Turner. Reporte de caso / Myofunctional relation and orthodontic treatment in patient with Turner syndrome. Case report

El síndrome de Turner es un desorden cromosómico, generado por la pérdida parcial o total de un cromosoma X. Las mujeres que lo presentan, pueden tener una serie de altera- ciones físicas y funcionales. El objetivo de este estudio es exponer el caso de una paciente con diagnóstico de síndrome de Turner, hipotonía muscular y maloclusión severa que fue tratada con terapia muscular craneofacial, combinada con ortodoncia en la Unidad de Malformación Craneofacial de la Facultad de Odontología de la Universidad de Chile.

The Turner Syndrome is a chromosome disorder produced by the total or partial absent of an X chromosome. The women who presents Turner syndrome can have a series of physical and functional alterations. The aim of this study is to present the case of a patient diagnosed with Turner syndrome, muscular hypotony and severe malocclusio treated with craneofacial muscular therapy combined with orthodontics at the Craneo- facial Malformations Unit of the Faculty of Dentistry, University of Chile.

Comparison of hip extension and rotation ranges of motion in young elite tennis players with and without history of low back pain.

BACKGROUND: Although low back pain (LBP) is known to be multi-factorial, certain studies have suggested that a deficit in hip extension and rotation range of motion (ROM) may be associated with LBP in athletes. OBJETIVE: The purpose of this study was to compare hip extension and rotation ROMs in elite tennis players with and without a history of LBP. METHODS: Forty-two male and 22 female young elite tennis players completed this study. Participants were divided into two groups: (1) 32 with history of LBP and (2) 32 without history of LBP. Descriptive measures of passive hip extension and rotation ROMs of the dominant and non-dominant limbs were taken. Active hip rotation ROMs were also assessed. Magnitude-based inferences on differences between groups and legs were made by standardizing differences. RESULTS: The inter-group statistical analysis reported no significant differences (p> 0.05; trivial effect with a probability higher than 95%; d⩽ 0.4) in any ROM measure analyzed. Further, neither LBP group nor control group reported significant bilateral or side-to-side differences (p> 0.05; trivial effect with a probability higher than 99%; d< 0.3) between legs regarding hip extension and rotation ROM measures. CONCLUSION: No relationship between hip extension and rotation ROM and history of LBP was found.

Different neuromuscular parameters influence dynamic balance in male and female football players.

PURPOSE: To analyse the relationship between several parameters of neuromuscular performance with unilateral dynamic balance measured through the Y-Balance test, as well as to determine the possible sex-related differences. METHODS: The Y-Balance test, isokinetic (concentric and eccentric) knee flexion and extension strength, isometric hip abduction and adduction strength, lower extremity joint range of motion (ROM) (hip, knee and ankle) and core stability were assessed in male (n = 88) and female (n = 44) professional football players. A stepwise multivariate linear least square regression with backward elimination analysis was carried out to identify a group of factors that were independently associated with balance performance in both sexes. RESULTS: Passive hip flexion and ankle dorsiflexion with knee flexed ROM were the main factors that retained a significant association to dominant (R2 = 23.1) and non-dominant (R2 = 33.5) balance scores for males. For females, core stability, hip abduction isometric peak torque, passive hip abduction and ankle dorsiflexion with knee flexed ROM variables retained a significant association with balance scores for both, dominant (R2 = 38.2) and non-dominant (R2 = 46.9) legs. CONCLUSIONS: Training interventions aimed at improving or maintaining unilateral dynamic balance in male football players should include, among other things, stretching exercises for the posterior chain of the lower extremity. However, females should also include exercises for strength and mobility of the hip abductors and core stability (especially in the frontal plane). This knowledge would allow clinicians and sport practitioners to develop more effective and tailored unilateral dynamic balance training interventions in male and female football players, possibly improving performance and reducing the risk of injury. LEVEL OF EVIDENCE: III.

The effect of smartphone addiction on hand joints in psoriatic patients: an ultrasound-based study.

BACKGROUND: Distal interphalangeal (DIP) arthritis is a frequent form of psoriatic arthritis being often linked to nail psoriasis. Modern society is characterized by overuse of smartphones. Indeed, literature has recently focalized on research into smartphone addiction and health-related problems. OBJECTIVES: As smartphone addiction is able to determine overuse and repeated movements of DIP joints and nails, the aim of this study was to evaluate the impact of smartphone use on hand joints of young psoriatic patients. METHODS: An observational study involving four different groups such as non-smartphone-addicted (SA) psoriatic patients, SA psoriatic patients, non-SA controls and SA controls was performed. Each subject underwent an ultrasound examination of both hands by three independent and blinded to group assignment radiologists. A specific score was used to evaluate the inflammatory state of the analysed joints. RESULTS: The total ultrasound score was statistically significantly higher in SA controls respect to non-SA controls (3.4 vs. 1.4; P < 0.05) as well as in SA psoriasis patients compared to non-SA psoriatic subjects (15.2 vs. 6.7; P < 0.01). Higher mean of ultrasound score was found for left hand in controls (both SA or not) and for right hand in psoriatic subjects (both SA or not), however without reaching statistical significance. CONCLUSIONS: Smartphone overuse was found to be linked with higher signs of inflammation of musculoskeletal structures of hands joints in both psoriasis and controls through ultrasound examination. Therefore, smartphone overuse may be a factor which facilitate or speed up the possible development of psoriatic arthritis.

Rational ideation and empiric validation of an innovative digital dermographic tester.

BACKGROUND: Dermographism is a condition characterized by a weal response to a combination of pressure and traction on skin surface, and its diagnosis is based on medical history, clinical criteria and provocation test. The Dermographic Tester® , a pen-sized tool containing a spring-loaded blunt tip, is the most widely used instrument for the provocation test, and it exerts increasing pressures on the skin surface according to an arbitrary units (AU) scale. Analysing the mechanism of function and trying to convert the AUs to SI units (g/mm2 ), we found that this instrument had some defects and limits that would compromise a true and repeatable quantification of the weal response threshold. Consequently, we decided to develop a new instrument, the Digital Dermographic Tester (DDT), which is engineered with an inside force sensor to implement features lacking in the current tools, in the hope of enhancing the precision of the provocation test. AIM: To validate the effectiveness and accuracy of the DDT. METHODS: We tested the DDT on 213 participants purposely sampled to obtain three groups, each with a different pattern of reaction to mechanical stimuli. Based on anamnestic, diagnostic and symptomatic criteria, patients were divided into dermographic urticaria (DU), spontaneous urticaria (SU) and healthy control (HC) groups. The DDT was used to apply 12 levels of pressure to the skin surface, and a frequency distribution of positive reactions was displayed for each group. RESULTS: A force of 36-40 g/mm2 appropriately differentiated physiological from pathological conditions with high sensitivity and specificity. CONCLUSIONS: The DDT was found to be capable of differentiating patients with DU patients from those with SU and from HCs, and was able to precisely identify the weal elicitation threshold.

Consensus on the management of patients with psoriatic arthritis in a dermatology setting.

BACKGROUND: Psoriatic arthritis (PsA) is a chronic inflammatory disease associated with psoriasis (PsO). Early diagnosis and prompt therapeutic intervention are crucial for limiting PsA progression and prevention of disability. Dermatologists are in a privileged position to detect early PsA. The management of patients with PsA in the dermatology setting is widely variable. OBJECTIVE: To provide practical recommendations for the management of patients with PsA in the dermatology setting including early diagnosis and treatment. METHODS: A consensus document was written by an expert panel composed by dermatologists (n = 12) and rheumatologists (n = 6). Eleven highly relevant questions were selected and elaborated with answers/statements based on a narrative literature review. The resulting document was discussed in a face-to-face meeting adopting a nominal group technique to reach consensus (i.e. 100% agreement) using the Delphi method. RESULTS: A consensus was achieved in defining the following: the clinical characteristics differentiating inflammatory and non-inflammatory signs and symptoms of joint disease; the most important differential diagnoses of PsA in clinical practice; the most useful screening questionnaires, serum laboratory tests and imaging techniques for the detection of early PsA; the criteria for dermatologist to refer patients with PsO to rheumatologist; the criteria for the diagnosis of PsA; the selection of the indices that the dermatologist could use for measuring the activity and severity of PsA in clinical practice; when systemic steroids and/or intra-articular steroid injections are indicated in the treatment of PsA. Finally, systemic treatments including synthetic and biologic disease-modifying antirheumatic drugs to be considered for the treatment of PsA have been reported. CONCLUSIONS: The implementations of these practical recommendations could be very helpful for the management of patients with PsA in the dermatology setting including early diagnosis and treatment.

Frecuencia de hígado graso no alcohólico diagnosticado por ecografía abdominal en pacientes obesos / Frequency of fatty liver nonalcoholic diagnosed by abdominal ultrasound in patients obese

El hígado graso no alcohólico (HGNA) es una complicación asociada a la obesidad, debido a la acumulación excesiva de grasa en el hígado. Con el objetivo de determinar la frecuencia de hígado graso no alcohólico diagnosticado por ecografía abdominal en pacientes que asisten a la Unidad del Manejo Integral del Paciente Obeso del Hospital de Clínicas, FCM ­ UNA, se realizó un estudio observacional descriptivo retrospectivo que incluyó a 188 pacientes, de los cuales 146 fueron mujeres y 42 hombres, la edad media en los pacientes con diagnóstico de HGNA fue de 41,3±11,4 años con un rango de edad de 20 a 65 años. Los resultados señalan la frecuencia de HGNA con el 56,9% (n=107) por ecografía abdominal, siendo 39,9% (n=75) mujeres y 17% (n=32) hombres, mientras que 43,1% (n=81) presentó hígado de aspecto normal. El 43,9% (n=47) de los pacientes con HGNA exhibió obesidad grado III. Al comparar la circunferencia abdominal en los 107 pacientes con HGNA se obtuvo una media de 139,1±97,8 cm. Con respecto al grado de esteatosis el 43,1% (n=81) mostró grado 0, 31,9% (n=60) grado 1, 20,7% (n=39) grado 2 y 4,3% (n=8) grado 3. Se observaron en los datos de laboratorio elevación de las transaminasas GPT 35,5% (n=38), 25,2% (n=27) en la GOT y 24,3% (n=26) FA, se notó aumento en los valores de las bilirrubinas directa e indirecta, 65,4% (n=70) BD y 69,2% (n=74) BI, por otra parte el 47,7% (n=51) enseñó CT elevado, 49% (n=45,7) HDL disminuido, 36,4% (n=39) LDL elevado y 29% (n=31) con triglicéridos elevados. Se halló que el 69,1% (n=74) de los pacientes con HGNA tienen HTA. Al realizar la comparación de las variables mencionadas entre los pacientes con y sin HGNA, arrojó que las transaminasas GPT, GOT y triglicéridos estuvieron en niveles más altos en los pacientes con HGNA. Se evidenció que la obesidad es un factor determinante para el desarrollo de HGNA, la caracterización del perfil hepático y lipídico, asimismo la presión arterial constituyen puntos fundamentales para asociar el aumento de estos con la presencia de HGNA.

Nonalcoholic fatty liver disease (NAFLD) is a complication associated with obesity, due to excessive accumulation of fat in the liver. In order to determine the frequency of NAFLD diagnosed by abdominal ultrasound in patients attending the unit Comprehensive Patient Management Obese the Hospital of Clinics, FCM - UNA, a retrospective observational study involving performed in 188 patients, of which 146 were women and 42 men, average age in patients with NAFLD diagnosis was 41,3±11,4 years with an age range of 20 - 65 years. The results indicate the frequency of NAFLD with 56,9% (n=107) for abdominal ultrasound, being 39,9% (n=75) women and 17% (n=32) were men, while 43,1% (n=81) presented liver normal. 43.9% (n=47) of patients with NAFLD showed grade III obesity. By comparing the abdominal circumference in 107 patients with NAFLD an average of 139,1±97,8 cm was obtained. With respect to the degree of steatosis 43,1% (n=81) showed grade 0, 31,9% (n=60) grade 1, 20,7% (n=39) grade 2 and 4,3% (n=8) grade 3 were observed in laboratory data GPT transaminases elevation of 35,5% (n=38), 25.2% (n=27) in the GOT and 24,3% (n=26) FA, increased values of direct and indirect bilirubin, 65,4% (n = 70) BD and 69.2% (n=74) BI was noted, moreover 47,7% (n=51) CT taught high, 49% (n=45,7) decreased HDL, 36,4% (n=39) high LDL and 29% (n=31) with elevated triglycerides. It was found that 69,1% (n=74) of patients with NAFLD have hypertension. When comparing the variables mentioned among patients with and without NAFLD, he threw the GPT, GOT transaminases and triglycerides were at higher levels in patients with NAFLD. It was evident that obesity is a determining factor NAFLD development, characterization of liver and lipid profile, blood pressure also are key points to associate these increased with the presence of NAFLD.

A definition for aggressive disease in patients with HER-2 negative metastatic breast cancer: an expert consensus of the Spanish Society of Medical Oncology (SEOM)

Purpose. To converge on an expert opinion to define aggressive disease in patients with HER2-negative mBC using a modified Delphi methodology. Methods. A panel of 21 breast cancer experts from the Spanish Society of Medical Oncology agreed upon a survey which comprised 47 questions that were grouped into three sections: relevance for defining aggressive disease, aggressive disease criteria and therapeutic goals. Answers were rated using a 9-point Likert scale of relevance or agreement. Results. Among the 88 oncologists that were invited to participate, 81 answered the first round (92%), 70 answered the second round (80%), and 67 answered the third round (76%) of the survey. There was strong agreement regarding the fact that identifying patients with aggressive disease needs to be adequately addressed to help practitioners to decide the best treatment options for patients with HER2-negative mBC. The factors that were considered to be strongly relevant to classifying patients with aggressive HER2-negative mBC were a high tumor burden, a disease-free interval of less than 12-24 months after surgery, the presence of progressive disease during adjuvant or neoadjuvant chemotherapy and having a triple-negative phenotype. The main therapeutic goals were controlling symptoms, improving quality of life and increasing the time to progression and overall survival. Conclusions. High tumor burden, time to recurrence after prior therapy and having a triple-negative phenotype were the prognostic factors for which the greatest consensus was found for identifying patients with aggressive HER2-negative mBC. Identifying patients with aggressive disease leads to different therapeutic approaches (AU)

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Is Predominant Clonal Evolution a Common Evolutionary Adaptation to Parasitism in Pathogenic Parasitic Protozoa, Fungi, Bacteria, and Viruses?

We propose that predominant clonal evolution (PCE) in microbial pathogens be defined as restrained recombination on an evolutionary scale, with genetic exchange scarce enough to not break the prevalent pattern of clonal population structure. The main features of PCE are (1) strong linkage disequilibrium, (2) the widespread occurrence of stable genetic clusters blurred by occasional bouts of genetic exchange ('near-clades'), (3) the existence of a "clonality threshold", beyond which recombination is efficiently countered by PCE, and near-clades irreversibly diverge. We hypothesize that the PCE features are not mainly due to natural selection but also chiefly originate from in-built genetic properties of pathogens. We show that the PCE model obtains even in microbes that have been considered as 'highly recombining', such as Neisseria meningitidis, and that some clonality features are observed even in Plasmodium, which has been long described as panmictic. Lastly, we provide evidence that PCE features are also observed in viruses, taking into account their extremely fast genetic turnover. The PCE model provides a convenient population genetic framework for any kind of micropathogen. It makes it possible to describe convenient units of analysis (clones and near-clades) for all applied studies. Due to PCE features, these units of analysis are stable in space and time, and clearly delimited. The PCE model opens up the possibility of revisiting the problem of species definition in these organisms. We hypothesize that PCE constitutes a major evolutionary strategy for protozoa, fungi, bacteria, and viruses to adapt to parasitism.

Italian guidelines on the systemic treatments of moderate-to-severe plaque psoriasis.

Psoriasis is a common disease, which has a considerable impact on the healthcare system. Therefore, appropriate use of therapeutic resources is very important. Management of psoriasis in daily clinical practice is highly variable because many issues are still debated and not definitely addressed by the evidence-based medicine. Moreover, the different availability and reimbursability of drugs in each country justifies national guidelines. Expert consensus can provide helpful guidelines for optimizing patient care. A total of 20 dermatologists from different areas of Italy and with large experience in the treatment of psoriasis agreed to participate in the guidelines expert panel who aimed to reach consensus on the factors influencing psoriasis severity, the indications for systemic treatments, the parameters to be considered in the choice of treatment, and the factors to be considered in the choice of biological treatment. The recommendations for the use, screening and monitoring of systemic therapies were based on the 2015 S3 European Dermatology Forum/European Academy of Dermatology and Venereology psoriasis guidelines. Recommendations on the treatment of psoriasis in special patient populations were also agreed. The final document was discussed in a meeting moderated by a facilitator with participation of the entire group and adopting a nominal group technique to reach consensus. A statement was regarded as consented when agreement was achieved by at least 75% of the voting experts according to the Delphi procedure.

The oncology day hospital in Spain: an updated analysis of Spanish Society of Medical Oncology (SEOM) looking forward

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Performance of the clinical index of stable febrile neutropenia (CISNE) in different types of infections and tumors

Purpose. The clinical index of stable febrile neutropenia (CISNE) can contribute to patient safety without increasing the complexity of decision-making. However, febrile neutropenia (FN) is a diverse syndrome. The aim of this analysis is to assess the performance of CISNE according to the type of tumor and infection and to characterize these patients. Methods. We prospectively recruited 1383 FN episodes in situations of apparent clinical stability. Bonferroni-adjusted z tests of proportions were used to assess the association between the infections suspected at the time of onset and the type of tumor with the risk of serious complications and mortality. The performance of CISNE was appraised in each category using the Breslow-Day test for homogeneity of odds ratios and Forest Plots. Results. 171 patients had a serious complication (12.3 %, 95 % confidence interval 10.7-14.2 %). The most common initial assumptive diagnoses were: fever without focus (34.5 %), upper respiratory infection (14.9 %), enteritis (12.7 %), stomatitis (11.8 %), and acute bronchitis (10.7 %). Lung and breast were the most common tumors, accounting for approximately 56 % of the series. The distribution of complications, mortality, and bacteremia varies for each of these categories. However, Breslow-Day tests indicate homogeneity of the odds ratio of the dichotomized CISNE score to predict complications in all infection and tumor subtypes. Conclusion. Despite FN’s clinical and microbiological heterogeneity, the CISNE score was seen to be consistent and robust in spite of these variations. Hence, it appears to be a safe tool in seemingly stable FN (AU)

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A definition for aggressive disease in patients with HER-2 negative metastatic breast cancer: an expert consensus of the Spanish Society of Medical Oncology (SEOM).

PURPOSE: To converge on an expert opinion to define aggressive disease in patients with HER2-negative mBC using a modified Delphi methodology. METHODS: A panel of 21 breast cancer experts from the Spanish Society of Medical Oncology agreed upon a survey which comprised 47 questions that were grouped into three sections: relevance for defining aggressive disease, aggressive disease criteria and therapeutic goals. Answers were rated using a 9-point Likert scale of relevance or agreement. RESULTS: Among the 88 oncologists that were invited to participate, 81 answered the first round (92%), 70 answered the second round (80%), and 67 answered the third round (76%) of the survey. There was strong agreement regarding the fact that identifying patients with aggressive disease needs to be adequately addressed to help practitioners to decide the best treatment options for patients with HER2-negative mBC. The factors that were considered to be strongly relevant to classifying patients with aggressive HER2-negative mBC were a high tumor burden, a disease-free interval of less than 12-24 months after surgery, the presence of progressive disease during adjuvant or neoadjuvant chemotherapy and having a triple-negative phenotype. The main therapeutic goals were controlling symptoms, improving quality of life and increasing the time to progression and overall survival. CONCLUSIONS: High tumor burden, time to recurrence after prior therapy and having a triple-negative phenotype were the prognostic factors for which the greatest consensus was found for identifying patients with aggressive HER2-negative mBC. Identifying patients with aggressive disease leads to different therapeutic approaches.