Future care for long-term cancer survivors: towards a new model.

PURPOSE: The increase in the prevalence "long-term cancer survivor" (LCS) patients is expected to increase the cost of LCS care. The aim of this study was to obtain information that would allow to optimise the current model of health management in Spain to adapt it to one of efficient LCS patient care. METHODS: This qualitative study was carried out using Delphi methodology. An advisory committee defined the criteria for participation, select the panel of experts, prepare the questionnaire, interpret the results and draft the final report. RESULTS: 232 people took part in the study (48 oncologists). Absolute consensus was reached in three of the proposed sections: oncological epidemiology, training of health professionals and ICT functions. CONCLUSION: The role of primary care in the clinical management of LCS patients needs to be upgraded, coordination with the oncologist and hospital care is essential. The funding model needs to be adapted to determine the funding conditions for new drugs and technologies.

Profile of patients who consult with internists for an osteoporosis assessment: The OSTEOMED registry.

BACKGROUND AND OBJECTIVES: Osteoporosis is considered a generalised skeletal disorder in which there is impaired bone resistance, which predisposes the individual to a greater risk of fracture. The aim of this cross-sectional study was to collect and present data on the main clinical characteristics of patients who consult medical internists in Spain. Understanding these characteristics can help in implementing action plans to improve these patients' care more effectively and efficiently. MATERIAL AND METHODS: Through an analysis of the Osteoporosis in Internal Medicine (OSTEOMED) registry, this study presents the main clinical characteristics of patients with osteoporosis who attended internal medicine consultations in 23 Spanish hospital centres between 2012 and 2017. We analysed the reasons for the consultations, the densitometric values, the presence of comorbidities, the prescribed treatment and other lifestyle-related factors. RESULTS: In total, 2024 patients with osteoporosis were assessed (89.87% women, 10.13% men). The patients' mean age was 64.1±12.1 years (women, 64.7±11.5 years; men, 61.2±14.2 years). There was no significant difference between the sexes in their history of recent falls (9.1% and 6.7%); however, there were significant differences in the daily intake of calcium from milk products (553.8±332.6mg for women vs. 450.2±303.3mg for men; p<.001) and in the secondary causes of osteoporosis (13% of men vs. 6.5% of women; p<.001). In the sample, there were 404 fractures (20%), with a notable number of confirmed vertebral fractures (17.2%, 35.6% in men vs. 15.2% in women; p<.001). A large portion of the patients did not undergo the indicated treatment and presented low levels of physical activity and sun exposure. A significant percentage of the patients presented associated comorbidities, the most common of which were hypertension (32%) and dyslipidaemia (28%). CONCLUSIONS: These results define the profile of patients with osteoporosis who attend internal medicine consultations in Spain. The results also show the multisystemic character of this condition, which, along with its high prevalence, determine that the specific internal medicine consultations dedicated to managing the condition are the appropriate place for caring for these patients.

Osteoporotic patients treated with bisphosphonates do not show the increased mortality observed in those untreated.

INTRODUCTION: Osteoporosis has been said to be associated with increased mortality. On the other hand, it is debated whether treatment with bisphosphonates may reduce mortality in osteoporotic patients. To contribute to the clarification of these issues, we have studied in a prospective cohort the mortality in people without osteoporosis and in patients with osteoporosis, untreated or treated with bisphosphonates MATERIAL AND METHODS: At their inclusion in the cohort, four groups of participants were identified: (a) people without osteoporosis (group 1); (b) osteoporotic patients treated with bisphosphonates (group 2); (c) osteoporotic patients who refused to be treated (group 3); and (d) patients who met osteoporosis diagnostic criteria but were not treated because their risk of fracture was considered to be low (group 4). To compare all four groups, unadjusted Kaplan-Meier estimates of survivorship were obtained and they were compared using log-rank test. Hazard ratios were then estimated via Cox regression adjusting for the main confounders. A comparison among the osteoporotic groups was made by means of a Cox regression analysis performed using only these three groups, adjusting for propensity scores. RESULTS: Two thousand six hundred and sixty-five people were included. In the unadjusted analysis, mortality in group 3 was higher than in the other groups (p < 0.001). Taking group 1 as a reference, Cox regression analysis showed the following mortality HRs for groups 2, 3, and 4 after adjusting for confounding factors: 0.82 (0.41-1.63), 1.37 (0.90-2.10), and 0.69 (0.46-1.02). In the analysis of the osteoporotic groups with the PS generated for them, and taking group 2 as a reference, the HRs were as follows: group 3, 2.38 (1.34-4.22); group 4, 1.45 (0.61-3.43). CONCLUSION: Mortality in osteoporotic patients who refused treatment is higher than in osteoporotic patients treated with bisphosphonates. In unadjusted analysis, it was also higher than in non-osteoporotic people; however, this difference disappeared after adjustment for confounding factors.

Vertebral fractures are increased in rheumatoid arthritis despite recent therapeutic advances: a case-control study.

Prevalence and risk factors of vertebral fractures in postmenopausal RA women were assessed in 323 patients and compared with 660 age-matched women. Of patients, 24.15% had at least one vertebral fracture vs.16.06% of controls. Age, glucocorticoids and falls were the main fracture risks. Vertebral fractures were associated with disease severity. INTRODUCTION: There is little quality data on the updated prevalence of fractures in rheumatoid arthritis (RA) that may have changed due to advances in the therapeutic strategy in recent years. This study was aimed at analysing the prevalence and risk factors of vertebral fractures in postmenopausal women with RA and comparing it with that of the general population. METHODS: We included 323 postmenopausal women diagnosed with RA from 19 Spanish Rheumatology Departments, randomly selected and recruited in 2018. Lateral radiographs of the thoracic and lumbar spine were obtained to evaluate morphometric vertebral fractures and the spinal deformity index. We analysed subject characteristics, factors related to RA, and fracture risk factors. The control group consisted of 660 age-matched Spanish postmenopausal women from the population-based Camargo cohort. RESULTS: Seventy-eight (24.15%) RA patients had at least one vertebral fracture. RA patients had increased fracture risk compared with controls (106 of 660, 16.06%) (p = 0.02). Logistic regression analysis showed that age (OR 2.17; 95% CI 1.27-4.00), glucocorticoids (OR 3.83; 95% CI 1.32-14.09) and falls (OR 3.57; 95% CI 1.91-6.86) were the independent predictors of vertebral fractures in RA patients. The subgroup with vertebral fractures had higher disease activity (DAS28: 3.15 vs. 2.78, p = 0.038) and disability (HAQ: 0.96 vs. 0.63, p = 0.049), as compared with those without vertebral fractures. CONCLUSION: The risk of vertebral fracture in RA is still high in recent years, when compared with the general population. The key determinants of fracture risk are age, glucocorticoids and falls. Patients with vertebral fractures have a more severe RA.

Perfil de los pacientes que acuden al médico internista para valoración de osteoporosis: registro OSTEOMED / Profile of patients who visit medical internists for an osteoporosis assessment: The OSTEOMED registry

Antecedentes y objetivo La osteoporosis se considera un trastorno generalizado del esqueleto en el que existe una alteración de la resistencia ósea que predispone a la persona a un mayor riesgo de fractura. Este estudio transversal pretende recoger y presentar las principales características clínicas de los pacientes que acuden a la consulta de los médicos internistas en España. Conocer estas características podría facilitar la puesta en marcha de planes de actuación para mejorar la atención de estos pacientes de manera más eficaz y eficiente. Material y métodos A través del análisis del registro OSTEOMED (Osteoporosis en Medicina Interna), este trabajo presenta las principales características clínicas de los pacientes con osteoporosis que acudieron a las consultas de Medicina Interna en 23 centros hospitalarios españoles entre 2012 y 2017. Se han analizado los motivos de consulta, los valores densitométricos, la presencia de comorbilidades, el tratamiento prescrito y otros factores relacionados con el estilo de vida. Resultados En total se evaluó a 2.024 pacientes con osteoporosis (89,87% mujeres, 10,13% hombres). La edad media de los pacientes fue de 64,1 ±12,1 años (mujeres, 64,7 ±11,5 años; hombres, 61,2 ±14,2 años). No hubo diferencia entre sexos en la historia de caídas recientes (9,1-6,7%), mientras que sí se apreció en la ingesta diaria de calcio de lácteos (553,8 ±332,6mg en mujeres vs. 450,2 ±303,3mg en hombres; p <0,001) y en causas secundarias de osteoporosis (13% de hombres vs. 6,5% de mujeres; p <0,001). En la muestra se observaron un total de 404 fracturas (20%) (AU)

Background and objectives Osteoporosis is considered a generalised skeletal disorder in which there is impaired bone resistance, which predisposes the individual to a greater risk of fracture. The aim of this cross-sectional study was to collect and present data on the main clinical characteristics of patients who consult medical internists in Spain. Understanding these characteristics can help in implementing action plans to improve these patients’ care more effectively and efficiently. Material and methods Through an analysis of the Osteoporosis in Internal Medicine (OSTEOMED) registry, this study presents the main clinical characteristics of patients with osteoporosis who attended internal medicine consultations in 23 Spanish hospital centres between 2012 and 2017. We analysed the reasons for the consultations, the densitometric values, the presence of comorbidities, the prescribed treatment and other lifestyle-related factors. Results In total, 2024 patients with osteoporosis were assessed (89.87% women, 10.13% men). The patients’ mean age was 64.1±12.1 years (women, 64.7±11.5 years; men, 61.2±14.2 years). There was no significant difference between the sexes in their history of recent falls (9.1% and 6.7%); however, there were significant differences in the daily intake of calcium from milk products (553.8±332.6mg for women vs. 450.2±303.3mg for men; P<.001) and in the secondary causes of osteoporosis (13% of men vs. 6.5% of women; P<.001). In the sample, there were 404 fractures (20%), with a notable number of confirmed vertebral fractures (17.2%, 35.6% in men vs. 15.2% in women; P<.001) (AU)

Adaptación transcultural y características de la versión española de la escala COMFORT Behavior Scale en el paciente crítico pediátrico / Transcultural adaptation and characteristics of the Spanish version of the COMFORT Behavior Scale in pediatric critical care patients

OBJETIVOS: Determinar las propiedades métricas de la escala COMFORT Behavior Scale desarrollada por van Dijk et al. (2000) en el contexto del paciente crítico pediátrico. DISEÑO: Estudio observacional, psicométrico y prospectivo. LUGAR DE ESTUDIO: Unidad de Cuidados Intensivos de un hospital pediátrico y universitario de tercer nivel asistencial. PACIENTES: Un total de 311 niños con una mediana de edad de 5,07 años (0,9-11,7). INTERVENCIONES: Ninguna. PRINCIPALES VARIABLES Y RESULTADOS: La escala fue administrada de forma simultánea por 2enfermeros a 311 pacientes ingresados en una unidad de críticos de 18 camas de un hospital pediátrico de tercer nivel asistencial. La versión española de la COMFORT Behavior Scale obtuvo un alfa de Cronbach de 0,715 y está compuesta por 3factores, con 2ítems cada uno: 1) alerta y movimiento físico; 2) calma/agitación y respuesta respiratoria/llanto, y 3) tono muscular y tensión facial. CONCLUSIONES: La escala COMFORT B logró ser adaptada al idioma español y mostró ser válida para determinar y cuantificar el grado de confort en un grupo de niños ingresados en una unidad de cuidados pediátricos española

OBJECTIVES: To determine the measurement properties of the Spanish version of the COMFORT Behavior Scale developed by van Dijk et al. (2000) in pediatric critical care patients. DESIGN: Prospective observational and psychometric study. SETTING: Level III Intensive Care Area at a university's children hospital. PATIENTS: A total of 311 children with median age of 5.07 years (IQR = 0.9-11.7). INTERVENTIONS: None. PRINCIPAL VARIABLES AND RESULTS: To determine the measurement properties the Spanish version of the COMFORT Behavior Scale was simultaneous administered by 2nurses to 311 patients admitted to an eighteen-bed critical care unit of a third level pediatric hospital. The Spanish version of the COMFORT Behavior Scale obtained a Cronbach alpha coefficient of 0.715 and it is a tool made up of 3factors with 2items: 1) alertness and physical movement; 2) calmness/agitation and respiratory response/crying, and 3) muscle tone and facial tension. CONCLUSIONS: The COMFORT B was adapted to Spanish and it has shown to be a valid an reliable tool to assess comfort in a group of children admitted to an Spanish Intensive Care Unit

Profile of patients who visit medical internists for an osteoporosis assessment: The OSTEOMED registry. / Perfil de los pacientes que acuden al médico internista para valoración de osteoporosis: registro OSTEOMED.

BACKGROUND AND OBJECTIVES: Osteoporosis is considered a generalised skeletal disorder in which there is impaired bone resistance, which predisposes the individual to a greater risk of fracture. The aim of this cross-sectional study was to collect and present data on the main clinical characteristics of patients who consult medical internists in Spain. Understanding these characteristics can help in implementing action plans to improve these patients' care more effectively and efficiently. MATERIAL AND METHODS: Through an analysis of the Osteoporosis in Internal Medicine (OSTEOMED) registry, this study presents the main clinical characteristics of patients with osteoporosis who attended internal medicine consultations in 23 Spanish hospital centres between 2012 and 2017. We analysed the reasons for the consultations, the densitometric values, the presence of comorbidities, the prescribed treatment and other lifestyle-related factors. RESULTS: In total, 2024 patients with osteoporosis were assessed (89.87% women, 10.13% men). The patients' mean age was 64.1±12.1 years (women, 64.7±11.5 years; men, 61.2±14.2 years). There was no significant difference between the sexes in their history of recent falls (9.1% and 6.7%); however, there were significant differences in the daily intake of calcium from milk products (553.8±332.6mg for women vs. 450.2±303.3mg for men; P<.001) and in the secondary causes of osteoporosis (13% of men vs. 6.5% of women; P<.001). In the sample, there were 404 fractures (20%), with a notable number of confirmed vertebral fractures (17.2%, 35.6% in men vs. 15.2% in women; P<.001). A large portion of the patients did not undergo the indicated treatment and presented low levels of physical activity and sun exposure. A significant percentage of the patients presented associated comorbidities, the most common of which were hypertension (32%) and dyslipidaemia (28%). CONCLUSIONS: These results define the profile of patients with osteoporosis who attend internal medicine consultations in Spain. The results also show the multisystemic character of this condition, which, along with its high prevalence, determine that the specific internal medicine consultations dedicated to managing the condition are the appropriate place for caring for these patients.

Expectations of nursing degree students: A longitudinal analysis.

BACKGROUND: The expectations of students regarding their studies have a strong influence on their academic performance and personal training, and they are closely related with their academic and professional future. OBJECTIVES: To analyze initial expectations and how they are fulfilled, in a cohort of nursing students during the four years of their degree program. DESIGN: Creation and validation of a questionnaire and longitudinal study. SETTING: University nursing school in Catalonia (Spain). PARTICIPANTS: 339 students of the nursing degree. METHODS: Two questionnaires were constructed with 10 items each, of a mixed nature: some items were previously validated in prior studies while other new items were made and included, following a review of the literature. The questionnaires were designed to assess the expectations of the students at the beginning of the academic year (CUDEX questionnaire) and the fulfillment of these at the end of the year (CUDEX-C questionnaire). RESULTS: Internal consistency (Cronbach's alpha) for the CUDEX questionnaire and the CUDEX-C was 0.70. Factorial analysis of the expectations questionnaires suggested a three-factor model, with an acceptable internal consistency for each of the factors. Statistically significant differences were found between the initial expectations and their fulfillment at the end of the academic year for all the factors and in all four years of the degree program. CONCLUSIONS: The three-factor model of the expectations (Academic adaptation, personal development, and academic performance) shows a good fit for the several samples and time points. The nursing students feel that not all of their expectations were fulfilled during their studies, and there were significant differences between their initial expectations and those fulfilled, in terms of all three factors.

100% peer review in radiation oncology: is it feasible?

PURPOSE: Peer review has been proposed as a strategy to ensure patient safety and plan quality in radiation oncology. Despite its potential benefits, barriers commonly exist to its optimal implementation in daily clinical routine. Our purpose is to analyze peer-review process at our institution. METHODS AND MATERIALS: Based on our group peer-review process, we quantified the rate of plan changes, time and resources needed for this process. Prospectively, data on cases presented at our institutional peer-review conference attended by physicians, resident physicians and physicists were collected. Items such as time to present per case, type of patient (adult or pediatric), treatment intent, dose, aimed technique, disease location and receipt of previous radiation were gathered. Cases were then analyzed to determine the rate of major change, minor change and plan rejection after presentation as well as the median time per session. RESULTS: Over a period of 4 weeks, 148 cases were reviewed. Median of attendants was six physicians, three in-training-physicians and one physicist. Median time per session was 38 (4-72) minutes. 59.5% of cases presented in 1-4 min, 32.4% in 5-9 min and 8.1% in ≥ 10 min. 79.1% of cases were accepted without changes, 11.5% with minor changes, 6% with major changes and 3.4% were rejected with indication of new presentation. Most frequent reason of change was contouring corrections (53.8%) followed by dose or fractionation (26.9%). CONCLUSION: Everyday group consensus peer review is an efficient manner to recollect clinical and technical data of cases presented to ensure quality radiation care before initiation of treatment as well as ensuring department quality in a feedback team environment. This model is feasible within the normal operation of every radiation oncology Department.

Impact of real-time, dose-escalated permanent seed implant brachytherapy in intermediate-risk prostate cancer.

PURPOSE: To retrospectively evaluate biochemical control and toxicity in patients who underwent 125I seed brachytherapy (BT) for intermediate-risk prostate cancer (PCa). MATERIALS AND METHODS: Between January 2004-December 2014, 395 patients with intermediate-risk PCa underwent 125I BT. Of these, 117 underwent preoperative planning (PP; 145 Gy) and 278 real-time intraoperative preplanning (IoP; 160 Gy). All patients were followed for ≥ 6 months (> 5 years in 48% of patients and > 7 years in 13%). Median follow-up was 59 months. RESULTS: Biochemical relapse-free survival (BRFS) rates at 5 and 8 years were, respectively, 91.7% and 82.1%. By treatment group, the corresponding BRFS rates were 93.5% and 90% for IoP and 89% and 76.8% for PP. The maximum dose to the urethra remained unchanged (217 Gy) despite the dose escalation (from 145 to 160 Gy), without any significant increase in treatment-related toxicity (p = 0.13). Overall toxicity outcomes in the series were excellent, with only 3 cases (0.76%) of grade 3 genitourinary toxicity. CONCLUSION: The real-time intraoperative planning technique at 160 Gy yields better biochemical controls than the preoperative planning technique at 145 Gy. Dose escalation did not increase urinary toxicity. The excellent results obtained with the IoP BT technique support its use as the first treatment option in this patient population.

Transcultural adaptation and characteristics of the Spanish version of the COMFORT Behavior Scale in pediatric critical care patients. / Adaptación transcultural y características de la versión española de la escala COMFORT Behavior Scale en el paciente crítico pediátrico.

OBJECTIVES: To determine the measurement properties of the Spanish version of the COMFORT Behavior Scale developed by van Dijk et al. (2000) in pediatric critical care patients. DESIGN: Prospective observational and psychometric study. SETTING: Level III Intensive Care Area at a university's children hospital. PATIENTS: A total of 311 children with median age of 5.07 years (IQR = 0.9-11.7). INTERVENTIONS: None. PRINCIPAL VARIABLES AND RESULTS: To determine the measurement properties the Spanish version of the COMFORT Behavior Scale was simultaneous administered by 2nurses to 311 patients admitted to an eighteen-bed critical care unit of a third level pediatric hospital. The Spanish version of the COMFORT Behavior Scale obtained a Cronbach alpha coefficient of 0.715 and it is a tool made up of 3factors with 2items: 1) alertness and physical movement; 2) calmness/agitation and respiratory response/crying, and 3) muscle tone and facial tension. CONCLUSIONS: The COMFORT B was adapted to Spanish and it has shown to be a valid an reliable tool to assess comfort in a group of children admitted to an Spanish Intensive Care Unit.

Atipias de células escamosas de significado incierto (ASCUS) y lesión escamosa intraepitelial de bajo grado (LSIL). Control citológico evolutivo a 3 meses. Resultados / Atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesion (LSIL). Evolutive cytologic control at 3 months. Results

Objetivo: Estudio prospectivo de 4 años (2015-2018) de casos de ASCUS y LSIL en la citología cervicovaginal y su control citológico evolutivo en 3 meses. Diseño: Estudio de: edad, paridad, abortos, nuligestas, menopáusicas, métodos contraceptivos, sexualidad y disfunciones sexuales, antecedentes patológicos; citología y virus del papiloma humano, comparando la evolución en ambos grupos. Resultados: La serie son 146 casos de ASCUS y 82 casos de LSIL. Hubo diferencias significativas en ASCUS, mayor en edad (p<0,02), paridad (p<0,001) y abortos (p<0,02). Hubo diferencia significativa en LSIL, mayor en nuligestas (p<0,001). Hubo diferencia significativa, p<0,02, en uso de condón, mayor en LSIL. En ambos grupos, >50% de los casos, no utilizaban ningún método anticonceptivo. No hubo diferencias significativas en la sexualidad ni en las disfunciones sexuales, ni en los antecedentes, entre ambos grupos. ASCUS se asoció a infecciones en el 15,05% y LSIL se asoció a infecciones en el 9,74%, sin diferencias. Hubo diferencia significativa en virus del papiloma humano negativo, p<0,01, mayor en ASCUS, 43,15% versus 20,73% en LSIL. Hubo diferencia significativa en otros virus de alto riesgo positivos, p<0,01, mayor en LSIL. En el control citológico a 3 meses hubo diferencia significativa en ASCUS+vaginosis bacteriana, p<0,02, mayor en LSIL. También en el grupo LSIL hubo más LSIL en el control a 3 meses en el 26,82% (p<0,01). En el seguimiento a un año no hubo diferencias significativas entre ambos grupos. Hubo citología negativa respectivamente en el 64,86% y en el 47,82%. Conclusión: La repetición de la citología a 3 meses tiene valor para descartar los falsos positivos y detectar las infecciones asociadas para poder tratarlas, lo que redundaría en anticipar la normalidad citológica

Objective: Prospective study of 4 years (2015-2018) of the ASCUS and LSIL cases in the vaginocervical cytology, and your evolutive cytological control in 3 months. Design: Study of: age, parity, nulligravides, menopausal, contraceptive methods, sexuality and sexual dysfunctions, pathologic antecedents, cytology and HPV (human papillomavirus) analysis, comparing the evolution in both groups. Results: The series are 146 cases of ASCUS and 82 cases of LSIL. In ASCUS, there were significant differences in age (P<.02), parity (P<.001), and abortions (P<.02). In LSIL, there were significant differences in nulligravides (P<.001). There were significant differences (P<.02) in condom use in LSIL. In both groups more of 50% of the cases dońt use any contraceptive method There were no significant differences in sexuality nor in sexual dysfunctions, neither in antecedents. ASCUS was associated with infections in 15,05%. LSIL was associated with infections in 9,74%, without differences. There were significant differences in negative HPV (P<.001) in ASCUS, 43,15% versus 20,73% in LSIL. There were significant differences in High Risk other viruses positive (P<.001) in LSIL. In the cytologic control at 3 monts, there were significant differences in ASCUS+BV (bacterial vaginosis) (P<.02) in LSIL. Also in LSIL group there were more LSIL in the cytologic control at 3 months, 26,82% (P<.01). In the follow-up at 1 year, there were no significant differences. The negative cytology was in 64,86% and 47,82%, respectively. Conclusion: The reiterative cytology in 3 months are value for detecting the associated infections, and treated; to run over and advance the cytologic normality

Detección de ITS (infecciones de trasmisión sexual) en mujeres afectas de ASCUS y LSIL en la citología cervicovaginal. Estudio prospectivo de 4 meses / Detection of STI (Sexual transmitted infections) in women affected by ASCUS and LSIL in the cervicovaginal cytology. Prospective study of 4 months

Objetivo: Estudio prospectivo a lo largo de 4 meses de las ITS (infecciones de trasmisión sexual) en mujeres diagnosticadas de ASCUS (atipias de las células escamosas de significado incierto) y LSIL (lesión escamosa intraepitelial de bajo grado) en la citología cervicovaginal en medio líquido. Diseño: Estudio de edad, paridad, abortos, nuligestas, fumadoras, métodos contraceptivos, antecedentes personales, citología, análisis de VPH-AR (virus del papiloma humano de alto riesgo) e ITS mediante RCP (reacción en cadena de la polimerasa, PCR en inglés) para Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum, Ureaplasma parvum y Trichomonas vaginalis. Resultados: La serie consta de 65 casos: 36 ASCUS y 29 LSIL. No hubo diferencias significativas en ningún parámetro entre ambos grupos. Las medias de edad fueron de 36,02 y 35,77 años, respectivamente. La paridad media fue 0,61 y 0,55 partos, respectivamente. Eran nuligestas el 44,44 y 48,27%, respectivamente. No hacían contracepción el 55,35 y 65,51%, respectivamente. Eran fumadoras el 25% en ASCUS y el 27,58% en LSIL. Hubo VPH negativo en el 41,66% en ASCUS y en el 31,03% en LSIL. El VPH-AR (+) se dio en el 68,33% en ASCUS y en el 68,96% en LSIL. Los VPH-AR más frecuentes fueron: otros de AR en el 50% en ASCUS y en el 62,06% en LSIL. VPH(+) e ITS (+) ocurrió en el 44,44% en ASCUS y en el 58,62% en LSIL, sin diferencias. El análisis para ITS fue negativo en el 30,55% en ASCUS y en el 20,68% en LSIL. Hubo más gérmenes detectados en el grupo LSIL, con diferencia significativa (p<0,05) para Gardnerella vaginalis, 17,24% en LSIL frente a 2,77% en ASCUS. Los gérmenes más frecuentes fueron: U. urealyticum en el 13,88% en ASCUS y en el 24,13% en LSIL; y U. parvum en el 36,11% en ASCUS y en el 44,82% en LSIL. Conclusion: El análisis de ITS es primordial, junto con la citología y el VPH, para detectar infecciones, a tratar, para poder regresar a la normalidad citológica

Objective: Prospective study along 4 months of STI (sexually transmitted infections) in women diagnosed with ASCUS (atypias of squamous cells of undetermined significance) and LSIL (low-grade squamous intraepithelial lesion) in the cervicovaginal cytology by liquid medium. Design: Study of: age, parity, abortions, nulligravides, smokers, contraceptive methods, personal antecedents, cytology, HR-HPV(high-risk human papilloma virus) analysis, STI analysis by PCR (polymerase chain reaction) for: Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum, Ureaplasma parvum, and Trichomonas vaginalis. Results: The series are 65 cases: 36 ASCUS and 29 LSIL. There weren't significant differences in any parameter between both groups. The means of age there were 36.02 and 35.77 years, respectively. The mean of parity was 0.61 and 0.55, respectively. They were nulligravides 44.44% in ASCUS and 48.27% in LSIL. No contraception was used in 55.35% in ASCUS and 65.51% in LSIL. The active smokers were 25% in ASCUS and 27.58% in LSIL. There was HPV negative in 41.66% in ASCUS and 31.03% in LSIL. There was HPV (+) in 68.33% in ASCUS and 68.86% in LSIL. The HPV-AR more frequent were: HR others in 50% in ASCUS and 62.06% in LSIL. HPV (+) and STI (+) occurred in 44.44% in ASCUS and 58.62% in LSIL. The STI analysis was negative in 30.55% in ASCUS and 20.68% in LSIL, without differences. There were more detected microorganisms in LSIL group, with significant difference (p<0.05) for Gardnerella vaginalis, 17,24% in LSIL versus 2,77% in ASCUS group. The more frequent microorganisms were: U. urealyticum, in 13.88% in ASCUS and 24.13% in LSIL; and U. parvum, in 36.11% in ASCUS and 44.82% in LSIL. Conclusion: The STI analysis is primordial, together to cytology and HPV-HR, for detect infections, to treat, to advance to the cytologic normality

Impact of the intellectual disability severity in the Spanish Personal Outcomes Scale.

BACKGROUND: The interest in measuring quality of life (QoL) in persons with intellectual disability (ID) has brought about a number of QoL measurements for this population. These measurements need to address two issues that have contributed to enhancing the current instruments. First, the necessity to develop measures with adequate psychometric properties, which has been discussed in recent studies, and second, the agreement between experts in analysing objective and subjective perspectives, as well as the use of self-report to include the participation of the person with ID. The question that we set out to investigate in this paper is whether the measurements function properly for the person with ID, independent of their level of severity. We used the Spanish version of the Personal Outcomes Scale, as it is a psychometrically sound instrument and includes three sources of information (the person with ID, a professional and a family member). METHOD: The sample was composed of 529 persons with ID (296 men, representing 55.95% of the total sample, and 233 women, with Mage  = 35.03, SD = 10.82) from several regions of Spain, along with their professional of reference and a family member. The severity variable was estimated for each item based on estimations of differential item functioning. RESULTS: The results showed that several items were undervalued by the assessments if the severity of the ID was greater. Mainly, this difference was observed in the assessments by professionals and in the dimensions of rights, personal development and self-determination. CONCLUSIONS: This paper focuses on the uses and interpretations of the results of the QoL measurements in the Personal Outcomes Scale. The results indicate that, in our sample, when people with high levels of ID are assessed, the functioning of some items are affected by the severity of this disability. For correct use, these items must be interpreted on the basis of the results obtained. Additionally, it is necessary to thoroughly review the QoL indicators for persons with severe or profound ID.

Review of the evidence on handling drugs and hazardous products in Urology Departments. Consensus document between the Spanish Urological Association and the Spanish Society of Hospital Pharmacy. / Revisión de la evidencia sobre el manejo de medicamentos y productos peligrosos en los servicios de Urología. Documento de consenso entre la Asociación Española de Urología y la Sociedad Española de Farmacia Hospitalaria.

BACKGROUND: The intravesical administration of hazardous drug products is a standard practice in the urology setting, which potentially exposing medical personnel to these drug products. It was deemed necessary to have a consensus document among the scientific societies involved (the Spanish Urological Association and the Spanish Society of Hospital Pharmacy) that collects the best available evidence on the safest handling possible of dangerous drug products in the setting of urology departments. METHODS: We reviewed the legislation and recommendations on the handling of dangerous drug products, both at the national and international level. RESULTS: There is national legislation and regulations for protecting workers who handle dangerous drugs and products, as well as recommendations for handling to protect both the product and workers. DISCUSSION: Following the strategic lines of the European Parliament for 2014-2020 in the chapter on occupational safety and health, the Spanish Urological Association and the Spanish Society of Hospital Pharmacy proposed a series of actions that decrease the risks of exposure for practitioners and caregivers involved in the handling of these products. CONCLUSIONS: After this review, 19 recommendations were established for handling dangerous drug products, which can be summarised as the need to train all individuals involved (from management teams to patients and caregivers), adopt systems that prevent contaminating leaks, implement exposure surveillance programmes and optimise available resources.

Safety and efficacy of various strains of bacille Calmette-Guérin in the treatment of bladder tumours in standard clinical practice. / Eficacia y seguridad de distintas cepas de BCG en el tratamiento del tumor vesical en práctica clínica habitual.

BACKGROUND: The natural progression of bladder tumours (nonmuscle-invasive bladder cancer [NMIBC]) is recurrence with a high rate of progression. Bacille Calmette-Guérin (BCG) has been shown effective in reducing these rates, but there are few comparative studies between strains. MATERIAL AND METHODS: An observational, prospective and multicentre registry studied 433 patients with a 12-month follow-up visit from 961 registered patients, assessing disease-free survival (DFS), progression-free survival (PFS) cancer-specific survival (CSS) and adverse effects. We studied the Tice, Russian, Tokyo, Connaught and RIVM strains. RESULTS: The sociodemographic data, NMIBC history, comorbidities, size, number, stage, grade, associated carcinoma in situ and transurethral resection were well balanced. DFS: There were 85 relapses (19.6%). The median DFS time was 20months. When comparing the various strains, we detected no statistically significant differences (log-rank test; P=.93). LPS: There were 33 cases of progression (7.62%). When comparing the various strains, we detected no statistically significant differences (log-rank test; P=.69). CSS: Seven patients died (1.68%). When comparing the various strains, we detected no statistically significant differences (log-rank test; P=.93). In terms of safety, 33.3% of the patients presented some type of adverse effect, mostly lower urinary symptoms (no urinary tract infections) <48h, >48h and haematuria. According to the Common Toxicity Criteria of the European Organisation for Research and Treatment of Cancer, 92.7% of the patients were grade1. There were no statistically significant differences between the strains. CONCLUSIONS: In this intermediate analysis, the risk of recurrence, progression, specific death and safety were independent of the BCG strain employed.

The Spanish version of the Self-Determination Inventory Student Report: application of item response theory to self-determination measurement.

BACKGROUND: A new measure of self-determination, the Self-Determination Inventory: Student Report (Spanish version), has recently been adapted and empirically validated in Spanish language. As it is the first instrument intended to measure self-determination in youth with and without disabilities, there is a need to further explore and strengthen its psychometric analysis based on item response patterns. METHOD: Through item response theory approach, this study examined item observed distributions across the essential characteristics of self-determination. RESULTS: The results demonstrated satisfactory to excellent item functioning patterns across characteristics, particularly within agentic action domains. Increased variability across items was also found within action-control beliefs dimensions, specifically within the self-realisation subdomain. CONCLUSIONS: These findings further support the instrument's psychometric properties and outline future research directions.

Radium-223 in the therapeutic sequence of metastatic castration-resistant prostate cancer. / Radio-223 en la secuencia terapéutica del cáncer de próstata resistente a la castración metastásico.

CONTEXT: Radium-223 is an □ -particle transmitter with specific action on bone metastases. The Alpharadin in Symptomatic Prostate Cancer Patients (ALSYMPCA) study showed that radium-223 extended overall survival and delayed the onset of bone events in patients with symptomatic castration-resistant prostate cancer with bone metastases (mCRPC) and without visceral metastases, with a good safety profile. OBJECTIVE: To review the new scientific evidence on radium-223 based on prespecified and post-hoc analyses of the ALSYMPCA study and on early-access programs after the publication of the ALSYMPCA study, thereby providing new data on the management of patients with mCRPC. ACQUISITION OF EVIDENCE: We searched for evidence on PubMed and in the abstracts of international urology and oncology congresses, as well as ongoing clinical trials (ClinicalTrials.gov). SYNTHESIS OF THE EVIDENCE: The results of the reviewed studies offer promising results that will broaden the therapeutic benefits of radium-223 to patients with mild symptoms and those with no symptoms. The results also provide preliminary evidence on the benefit of radium-223 treatment after the failure of docetaxel, enzalutamide or abiraterone or the combination of radium-223 with these agents or other therapeutic agents such as bone-targeted agents and immunotherapy. CONCLUSION: Radium-223 can be a treatment option for patients with mild symptoms and can provide a therapeutic benefit after failure of currently available treatments or in combination with these treatments. This evidence should be corroborated in clinical trials before being added to clinical practice.

Item response theory analysis applied to the Spanish version of the Personal Outcomes Scale.

BACKGROUND: The study of measurements of quality of life (QoL) is one of the great challenges of modern psychology and psychometric approaches. This issue has greater importance when examining QoL in populations that were historically treated on the basis of their deficiency, and recently, the focus has shifted to what each person values and desires in their life, as in cases of people with intellectual disability (ID). Many studies of QoL scales applied in this area have attempted to improve the validity and reliability of their components by incorporating various sources of information to achieve consistency in the data obtained. The adaptation of the Personal Outcomes Scale (POS) in Spanish has shown excellent psychometric attributes, and its administration has three sources of information: self-assessment, practitioner and family. The study of possible congruence or incongruence of observed distributions of each item between sources is therefore essential to ensure a correct interpretation of the measure. The aim of this paper was to analyse the observed distribution of items and dimensions from the three Spanish POS information sources cited earlier, using the item response theory. METHOD: We studied a sample of 529 people with ID and their respective practitioners and family member, and in each case, we analysed items and factors using Samejima's model of polytomic ordinal scales. RESULTS: The results indicated an important number of items with differential effects regarding sources, and in some cases, they indicated significant differences in the distribution of items, factors and sources of information. CONCLUSIONS: As a result of this analysis, we must affirm that the administration of the POS, considering three sources of information, was adequate overall, but a correct interpretation of the results requires that it obtain much more information to consider, as well as some specific items in specific dimensions. The overall ratings, if these comments are considered, could result in bias.