The neurobiology of insulin-like growth factor I: From neuroprotection to modulation of brain states.

After decades of research in the neurobiology of IGF-I, its role as a prototypical neurotrophic factor is undisputed. However, many of its actions in the adult brain indicate that this growth factor is not only involved in brain development or in the response to injury. Following a three-layer assessment of its role in the central nervous system, we consider that at the cellular level, IGF-I is indeed a bona fide neurotrophic factor, modulating along ontogeny the generation and function of all the major types of brain cells, contributing to sculpt brain architecture and adaptive responses to damage. At the circuit level, IGF-I modulates neuronal excitability and synaptic plasticity at multiple sites, whereas at the system level, IGF-I intervenes in energy allocation, proteostasis, circadian cycles, mood, and cognition. Local and peripheral sources of brain IGF-I input contribute to a spatially restricted, compartmentalized, and timed modulation of brain activity. To better define these variety of actions, we consider IGF-I a modulator of brain states. This definition aims to reconcile all aspects of IGF-I neurobiology, and may provide a new conceptual framework in the design of future research on the actions of this multitasking neuromodulator in the brain.

What is the sensitivity and specificity of the peer review process?

In this paper, we introduce the concepts of sensitivity and specificity to mathematically describe the accuracy of the peer review process. Sensitivity refers to the probability that the final decision for a manuscript would be acceptance, provided the manuscript meets the journal standards required for publication (i.e., true positive rate). Specificity refers to the probability that the final decision would be rejection, provided the work does not meet the standards required for publication (i.e., true negative rate). Therefore, in the peer review process, sensitivity measures the ability to correctly accept manuscripts that meet the required standards (true positives) and specificity measures the ability to correctly reject manuscripts that do not meet those quality standards required for publication (true negatives). Sensitivity and specificity values can inform the editor under what conditions the outcome of a peer review process becomes more precise and, therefore, if this does not occur, when the editor must improve the analysis involved in processing the information received from reviewers' reports. Sensitivity and specificity understood in this way can promote the ethical conduct of peer review processes and improve the validity of manuscript editorial decisions.

Pedestrian flow in two dimensions: Optimal psychological stress leads to less evacuation time and decongestion.

Collective motion is an innate ability of all living systems, which depends on physiological and psychosocial factors in the case of humans. Such a collective organization is becoming of great interest in collective motion in human crowds. Using a cellular automaton (CA) simulation model, we demonstrate that emergency egress from a two-dimensional corridor with optimal stress leads to less evacuation time and efficient mass evacuations. We study how three types of stress (i.e., mild stress, optimal stress, and anxiety) described in the literature have a significant impact on the collective dynamics. We found that low-stress levels could decrease the evacuation time in an entire occupied room since agents choose alternative routes rather than the shortest path to the exit and display cooperative behavior. Therefore, the combination of mild and optimal stress can lead to efficient evacuations. Also CA simulations may be used to find safer and more efficient ways to conduct mass evacuation procedures.

Simulating the city traffic complexity induced by traffic light periods.

We revisited the global traffic light optimization problem through a cellular automata model, which allows us to address the relationship between the traffic lights and car routing. We conclude that both aspects are not separable. Our results show that a good routing strategy weakens the importance of the traffic light period for mid-densities, thus limiting the parameter space where such optimization is relevant. This is confirmed by analyzing the travel time normalized by the shortest path between the origin and destination. As an unforeseen result, we report what seems to be a power-law distribution for such quantities, indicating that the travel time distribution slowly decreases for long travel times. The power-law exponent depends on the density, traffic light period, and routing strategy, which in this case is parametrized by the tendency of agents to abandon a route if it becomes stagnant. These results could have relevant consequences on how to improve the overall traffic efficiency in a particular city, thus providing insight into useful measurements, which are often counter-intuitive, which may be valuable to traffic controllers that operate through traffic light periods and phases.

Spread of the fascioliasis endemic area assessed by seasonal follow-up of rDNA ITS-2 sequenced lymnaeid populations in Cajamarca, Peru.

Fascioliasis is a worldwide emerging snail-borne zoonotic trematodiasis with a great spreading capacity linked to animal and human movements, climate change, and anthropogenic modifications of freshwater environments. South America is the continent with more human endemic areas caused by Fasciola hepatica, mainly in high altitude areas of Andean regions. The Peruvian Cajamarca area presents the highest human prevalences reported, only lower than those in the Bolivian Altiplano. Sequencing of the complete rDNA ITS-2 allowed for the specific and haplotype classification of lymnaeid snails collected in seasonal field surveys along a transect including 2007-3473 m altitudes. The species Galba truncatula (one haplotype preferentially in higher altitudes) and Pseudosuccinea columella (one haplotype in an isolated population), and the non-transmitting species Lymnaea schirazensis (two haplotypes mainly in lower altitudes) were found. Climatic seasonality proved to influence G. truncatula populations in temporarily dried habitats, whereas L. schirazensis appeared to be more climatologically independent due to its extreme amphibious ecology. Along the southeastern transect from Cajamarca city, G. truncatula and L. schirazensis shared the same site in 7 localities (46.7% of the water collections studied). The detection of G. truncatula in 11 new foci (73.3%), predominantly in northern localities closer to the city, demonstrate that the Cajamarca transmission risk area is markedly wider than previously considered. Lymnaea schirazensis progressively increases its presence when moving away from the city. Results highlight the usefulness of lymnaeid surveys to assess borders of the endemic area and inner distribution of transmission foci. Similar lymnaeid surveys are still in need to be performed in the wide northern and western zones of the Cajamarca city. The coexistence of more than one lymnaeid transmitting species, together with a morphologically indistinguishable non-transmitting species and livestock movements inside the area, conform a complex scenario which poses difficulties for the needed One Health control intervention.

Anti-alignment driven dynamics in the excited states of molecules under strong fields.

We develop two novel models of the H2+ molecule and its isotopes from which we assess quantum-mechanically and semi-classically whether the molecule anti-aligns with the field in the first excited electronic state. The results from both models allow us to predict anti-alignment dynamics even for the HD+ isotope, which possesses a permanent dipole moment. The molecule dissociates at angles perpendicular to the field polarization in both the excited and the ground electronic state, as the population is exchanged through a conical intersection. The quantum mechanical dispersion of the initial state is sufficient to cause full dissociation. We conclude that the stabilization of these molecules in the excited state through bond-hardening under a strong field is highly unlikely.

Knowledge, attitude, and practice regarding COVID-19 outbreak in Bangladesh: An online-based cross-sectional study.

In Bangladesh, an array of measures have been adopted to control the rapid spread of the COVID-19 epidemic. Such general population control measures could significantly influence perception, knowledge, attitudes, and practices (KAP) towards COVID-19. Here, we assessed KAP towards COVID-19 immediately after the lock-down measures were implemented and during the rapid rise period of the outbreak. Online-based cross-sectional study conducted from March 29 to April 19, 2020, involving Bangladeshi residents aged 12-64 years, recruited via social media. After consenting, participants completed an online survey assessing socio-demographic variables, perception, and KAP towards COVID-19. Of the 2017 survey participants, 59.8% were male, the majority were students (71.2%), aged 21-30 years (57.9%), having a bachelor's degree (61.0%), having family income >30,000 BDT (50.0%), and living in urban areas (69.8). The survey revealed that 48.3% of participants had more accurate knowledge, 62.3% had more positive attitudes, and 55.1% had more frequent practices regarding COVID-19 prevention. Majority (96.7%) of the participants agreed 'COVID-19 is a dangerous disease', almost all (98.7%) participants wore a face mask in crowded places, 98.8% agreed to report a suspected case to health authorities, and 93.8% implemented washing hands with soap and water. In multiple logistic regression analyses, COVID-19 more accurate knowledge was associated with age and residence. Sociodemographic factors such as being older, higher education, employment, monthly family income >30,000 BDT, and having more frequent prevention practices were the more positive attitude factors. More frequent prevention practice factors were associated with female sex, older age, higher education, family income > 30,000 BDT, urban area residence, and having more positive attitudes. To improve KAP of general populations is crucial during the rapid rise period of a pandemic outbreak such as COVID-19. Therefore, development of effective health education programs that incorporate considerations of KAP-modifying factors is needed.

Does following optimized routes for single cars improve car routing?

We study the impact of deserting a pre-established path, determined by a navigation software, on the overall city traffic. To do so, we consider a cellular automaton model for vehicular traffic, where the cars travel between two randomly assigned points in the city following three different navigation strategies based on the minimization of the individual paths or travel times. We found, in general, that, above a critical car density, the transport improves in all strategies if we decrease the time that the vehicles persist in trying to follow a particular strategy when a route is blocked, namely, the mean flux increases, the individual travel times decrease, and the fluctuations of density in the streets decrease; consequently, deserting helps prevent traffic jams.

Impact of intestinal dysbiosis-related drugs on the efficacy of immune checkpoint inhibitors in clinical practice.

PURPOSE: Intestinal dysbiosis has emerged as a biomarker of response to immune checkpoint inhibitors (ICIs). It can be caused by antibiotics, although it may also result from the use of other drugs that have been studied to a lesser extent. The objective of our study was to analyze the association between the use of potentially dysbiosis-related drugs and survival in patients treated with ICIs in the clinical practice. MATERIALS AND METHODS: A retrospective, multicenter, cohort study was conducted. Clinicopathological variables were collected and the concomitant use of drugs was analyzed. A descriptive analysis of variables and overall survival, estimated by the Kaplan-Meier method, was performed, and association with various independent variables was assessed using Cox regression. RESULTS: We included 253 patients, mainly with non-small cell lung cancer and melanoma. The most commonly used drugs were acid reducers, prescribed to 55.3% of patients, followed by corticosteroids (37.9%), anxiolytic drugs (35.6%), and antibiotics (20.5%). The use of acid reducers (9 vs. 18 months, P < .0001), antibiotics (7 vs. 15 months, P < .017), anxiolytic drugs (8 vs. 16 months, P < .015), and corticosteroids (6 vs. 19 months, P < .00001) was associated with poorer overall survival. Furthermore, the greater the number of drugs used concomitantly with ICIs, the higher the risk of death (1 drug: hazard ratio, 1.88; CI 95%, 1.07-3.30; 4 drugs: hazard ratio, 4.19; CI9 5%, 1.77-9.92; P < .001). CONCLUSION: Response to ICIs may be influenced by the use of drugs that lead to intestinal dysbiosis. Although a confirmatory prospective controlled study is required, our findings should be taken into account when analyzing ICI efficacy.

Magnetostatic interaction between two bubble skyrmions.

A detailed analytic and numerical analysis of the interaction between two bubble skyrmions has been carried out. The results from the micromagnetic calculations show that when the skyrmions are in the same plane, the magnetic parameters vary weakly as a function of the separation between them. On the other hand, when the skyrmions are located in the same vertical axis, the magnetic parameters show a strong variation as a function of the separation of the skyrmions. In particular, when a magnetic disk is over another, there is a transition from a Bloch-like skyrmion configuration to a Néel-like skyrmion configuration as the distance between the disks decreases, as a consequence of the magnetostatic interaction. Therefore, it is possible to stabilize a bubble skyrmion with a Néel configuration without the Dzyaloshinskii-Moriya interaction. Thus, these results can be used for the control of the skyrmion parameters in magnetic spintronic devices that need to use these configurations.

The Game Between a Biased Reviewer and His Editor.

This paper shows that, for a large range of parameters, the journal editor prefers to delegate the choice to review the manuscript to the biased referee. If the peer review process is informative and the review reports are costly for the reviewers, even biased referees with extreme scientific preferences may choose to become informed about the manuscript's quality. On the contrary, if the review process is potentially informative but the reviewer reports are not costly for the referees, the biased reviewer has no incentive to become informed about the manuscript. Furthermore, if the reports are costly for referees but the peer review processes are not potentially informative, the biased reviewers will never become informed. In this paper, we also present a web resource that helps editors to experiment with the review process as a device for information transmission.

Fentanilo de acción rápida como coadyuvante para el control de efectos adversos por inmunoterapia. Caso clínico / Immediate-release fentanyl as coadyuvant for control the side effects off immunotherapy. Clinical case

El avance científico y la aparición de la inmunoterapia en la oncología obliga a conocer tanto sus resultados en forma de supervivencia como la toxicidad que esta aporta. La estimulación farmacológica del sistema inmune puede producir distorsiones en la regulación del mismo, alterando el proceso de autotolerancia inmune y favoreciendo la aparición de reacciones autoinmunitarias desmedidas contra órganos sanos. La colitis autoinmune es un evento inmunorrelacionado que cursa habitualmente con diarrea. Pese a que el eje del tratamiento es el tratamiento corticoideo, no siempre se consigue controlar el efecto adverso ni el dolor que, en ocasiones, esta provoca. En nuestro caso, la utilización de fentanilo de acción rápida para control del dolor consiguió actuar colateralmente como coadyuvante al tratamiento inmunosupresor, enlenteciendo el tránsito intestinal y, por consiguiente, favoreciendo el control de la colitis (AU)

The scientific advance and the appearance of immunotherapy in oncology, requires to know both its results in the form of survival, and the toxicity that this contributes. Pharmacological stimulation of the immune system can cause distortions in the regulation of the immune system and alter the process of immune tolerance, favoring the appearance of excessive autoimmune reactions against healthy organs. Autoimmune colitis is an immunorelated event that usually courses with diarrhea. Although the treatment axis is corticoids, it is not always possible to control the adverse effect or the pain that, sometimes, these treatment cause. In our case, the use of fast-acting fentanyl for pain control was able to act as a coadjuvant to the immunosuppressive treatment, slowing the intestinal transit and, consequently, favoring the control of the colitis (AU)

Manejo de antiagregantes y anticoagulantes en procedimientos intervencionistas de dolor crónico / An update of the management of antiplatelet and antithrombotic therapy for interventional technics in chronic pain

Los especialistas en dolor crónico nos enfrentamos habitualmente a situaciones en las que los pacientes que van a ser sometidos a procedimientos intervencionistas están bajo tratamiento antiagregante o anticoagulante. Las complicaciones hemorrágicas pueden ser catastróficas cuando se trata de bloqueos profundos y técnicas dentro del canal espinal. Sin embargo, el riesgo de eventos tromboembólicos aumenta con la suspensión inadecuada de los fármacos antiagregantes y anticoagulantes en estos pacientes. A día de hoy no existen unos algoritmos o recomendaciones actualizadas para el manejo de estos pacientes en el área de dolor crónico. El objetivo de este documento es ofrecer unas recomendaciones de seguridad sobre el manejo de estos fármacos según el tipo de intervención y el tipo de paciente, con el objetivo de minimizar el riesgo de complicaciones hemorrágicas sin aumentar el riesgo de eventos tromboembólicos. Para ello, se han revisado las últimas publicaciones sobre el manejo fármacos que alteran la hemostasia en anestesia regional y otras técnicas de dolor crónico, incluyendo diferentes guías de manejo perioperatorio (ASRA, ESA, SEDAR...). Existe buena evidencia en el incremento del riesgo de eventos tromboembólicos en pacientes que suspenden la terapia antiagregante, y que este riesgo es mayor que el de la incidencia de hematomas epidurales en pacientes que continúan con el tratamiento, si bien ambos riesgos son significativos. Así mismo, existe buena evidencia de la incidencia de hematomas pidurales espontáneos asociados o no a punción traumática, en pacientes con o sin terapia antitrombótica. Estos hematomas epidurales espontáneos están asociados a factores favorecedores como la manipulación excesiva, el uso de agujas de mayor calibre, el uso de catéteres, los procedimientos sobre el canal cervical, la edad avanzada, y las anormalidades vasculares y anatómicas del paciente. Hay una tendencia menos conservadora hacia los intervalos de interrupción de los fármacos antiagregantes en pacientes de alto riesgo (Aspirina® 3 días, clopidogrel 5 días), si bien el manejo de heparinas y anticoagulantes orales clásicos prácticamente no ha cambiado. Recientemente han surgido nuevos anticoagulantes orales no contemplados en muchas de estas guías (dabigatran, rivaroxaban, apixaban) con mayor perfil de seguridad que el Sintrom®, habitualmente sin necesidad de terapia puente con heparinas tras la suspensión del fármaco. El inconveniente es que existe escasa documentación en la literatura sobre su manejo perioperatorio, por lo que su suspensión se basa actualmente en sus características farmacocinéticas y farmacodinámicas estrictas (2 días, siendo mayor si existe insuficiencia renal) (AU)

Interventional pain physicians usually face situations were, the patients that are going to be under an interventional procedure, are undergoing an antiplatelet or anticoagulant therapy. Bleeding complications can be catastrophic when we talk about deep blocks and interventions into the spinal canal. However, the risk of thromboembolic events increases with the improper discontinuation of antiplatelet and anticoagulant drugs in those patients. Nowadays, there are no algorithms or updated recommendations on the handling of those patients in the chronic pain area. The goal of this article is to offer some recommendations on how to use, in a safety way, those drugs depending on the type of intervention and patient, with the objective of minimizing the risk of bleeding complications without increasing the risk of thromboembolic events. To do this, the latest news on the use of drugs which alters the hemostasis in regional anesthesia and other chronic pain technics had been reviewed, including different guides on the perioperative management (ASRA, ESA, SEDAR, etc.). There is fair evidence that the risk of thromboembolic phenomenon increases on those patients whom discontinues their antiplatelet therapy, and that this risk is even higher than the risk of epidural hematomas on those patients whom continues with their treatment, even though both risks are significant. There is also good evidence of the incidence of spontaneous epidural hematomas, associated or not to a traumatic puncture, in patients with or without an antithrombotic therapy. Those spontaneous epidural hematomas are more likely associated to favorable factors such as: Excessive manipulation, the use of larger gauge needles, the use of catheters, procedures into the cervical spinal canal, elderly patients, and vascular and anatomical abnormalities of the patient. There is a less conservative tendency about intervals of discontinuation of antiplatelet drugs in high risk patients (3 days for Aspirin®, 5 days for clopidogrel), while the use of heparin and classic oral anticoagulants practically has not changed. Recently, new oral anticoagulants, not included in most of these guides, have appeared (dabigatran, rivaroxaban and apixaban) with a higher security profile than Sintrom®, usually without the need of heparin bridging therapy after discontinuation of the drug. The inconvenience is that there is limited evidence about its perioperative use. That is why it ́s suspension is actually based on its strict pharmacokinetic and pharmacodynamics characteristics (2 days, being higher if there exists a decline in renal function) (AU)

Totally endoscopic surgery on diastasis recti associated with midline hernias. The advantages of a minimally invasive approach. Prospective cohort study.

PURPOSE: To evaluate prospectively the feasibility and the duration of the plication of both aponeurosis through a totally endoscopic approach to the diastasis recti associated with midline hernias, correcting both pathologies simultaneously and objectively looking at their advantages and complications. METHODS: The prospective cohort study included patients suffering from midline hernias equal to or bigger than 2 cm size and associated diastasis recti, from April 2011 to October 2012. Full endoscopic subcutaneous approach is used to perform the surgery. An ultrasound scan was carried out to identify inter-rectus distances and recurrences in xiphoid, 3 cm supraumbilical and 2 cm subumbilical locations. RESULTS: A total of 21 patients were included in the study, with a mean follow-up of 20 months. The main complication was seroma. A significant reduction in the average distance between the rectus muscles was shown before surgery and at 1 month postoperative measures in all three locations (p < 0.001). No significant differences between the measured distances to the first and second year. A significant improvement at first postoperative year in cosmetic outcome compared with preoperative cosmetic condition (p < 0.001) was confirmed. Back pain improves significantly when diastasis recti is surgically corrected. CONCLUSIONS: Totally endoscopic approach to diastasis recti associated with midline hernias is a feasible and reproducible method. It brings considerable esthetic advantages. Diastasis or hernia recurrences in medium term follow-up have not been observed. Diastasis greater than 6-7 cm or associated with severe musculoaponeurotic laxity of the abdominal wall could benefit from the use of reinforced prosthesis.

Fiabilidad técnica del bloqueo caudal guiado con ecografía / Technical reliability of caudal block with ultrasound guided

Introducción: el bloqueo-infiltración caudal es una técnica utilizada en las unidades de dolor para tratar el dolor de origen radicular lumbosacro. Esta técnica se ha realizado clásicamente mediante referencias anatómicas o guiado mediante fluoroscopia. Se presenta la realización de la técnica eco-guiada y las complicaciones surgidas tras la realización de la misma. Material y métodos: estudio observacional descriptivo en el que se estudiaron las complicaciones de la técnica. Se realizaron 126 procedimientos en pacientes adultos de ambos sexos. Procedimiento: se localizó el hiato sacro mediante ecografía y se insertó una aguja de Touhy 18 G en el espacio epidural caudal perforando el ligamento sacro-coccígeo. Resultados: no surgieron complicaciones graves en ninguno de los pacientes. No hubo casos de mala ventana ecográfica por lo que se pudo realizar la técnica en todos los enfermos programados. Conclusión: debido a la ausencia de complicaciones la realización de la técnica eco-guiada es una alternativa segura y fiable a la técnica guiada con fluoroscopia. Mediante esta técnica se evita la exposición de radiaciones ionizantes. Además el bloqueo caudal eco-guiado no necesita del uso de contrastes yodados y permite transportar el ecógrafo a la cabecera del enfermo en caso de ser necesario (AU)

Introduction: Caudal block is a procedure used to treat lumbo- sacral root pain. This procedure has traditionally been realized using anatomy references or guided by fluoroscopy. The realization of sonography-guided technique and complications following the embodiment there of is presented Material and methods: Observational and descriptive study in which is studied procedure complications. One hundred and twenty-six caudal blocks were performed in adult patients of both sexes. Procedure: The sacral hiatus was located by ultrasound and 18 G Tuohy needle was inserted into the epidural space flow drilling the sacro-coccygeal ligament. Results: There were no serious complications arose in any of the patients. There were no cases of poor ultrasound window so they could perform the technique on all scheduled patients. Conclusions: The procedure sonography-guided is safe and reliable due to the absence of complications and is an alternative to flouoroscopy-guided technique. This technique of ionizing radiation exposure is avoided. In addition the caudal block does not need ionized contrast substances and let take the sonography machine bedsides if necessary (AU)

Solar wind thermally induced magnetic fluctuations.

A kinetic description of Alfvén-cyclotron magnetic fluctuations for anisotropic electron-proton quasistable plasmas is studied. An analytical treatment, based on the fluctuation-dissipation theorem, consistently shows that spontaneous fluctuations in plasmas with stable distributions significantly contribute to the observed magnetic fluctuations in the solar wind, as seen, for example, in [S. D. Bale et al., Phys. Rev. Lett. 103, 211101 (2009)], even far below from the instability thresholds. Furthermore, these results, which do not require any adjustable parameters or wave excitations, are consistent with the results provided by hybrid simulations. It is expected that this analysis contributes to our understanding of the nature of magnetic fluctuations in the solar wind.

Self-modulation of nonlinear Alfvén waves in a strongly magnetized relativistic electron-positron plasma.

We study the self-modulation of a circularly polarized Alfvén wave in a strongly magnetized relativistic electron-positron plasma with finite temperature. This nonlinear wave corresponds to an exact solution of the equations, with a dispersion relation that has two branches. For a large magnetic field, the Alfvén branch has two different zones, which we call the normal dispersion zone (where dω/dk>0) and the anomalous dispersion zone (where dω/dk<0). A nonlinear Schrödinger equation is derived in the normal dispersion zone of the Alfvén wave, where the wave envelope can evolve as a periodic wave train or as a solitary wave, depending on the initial condition. The maximum growth rate of the modulational instability decreases as the temperature is increased. We also study the Alfvén wave propagation in the anomalous dispersion zone, where a nonlinear wave equation is obtained. However, in this zone the wave envelope can evolve only as a periodic wave train.

Prevención de eventos adversos para la seguridad del paciente en las unidades de tratamiento del dolor crónico / Prevention of adverse events for patient safety in chronic pain treatment units

Objetivos. Identificar acciones preventivas que minimicen el riesgo para la seguridad de los pacientes atendidos en las unidades de tratamiento del dolor, y agrupar en lotes las acciones preventivas que presenten características homogéneas. El trabajo es una parte de un proyecto de mejora de la seguridad de pacientes atendidos en dichas unidades, cuyo propósito global ha sido la identificación, priorización y prevención de riesgos. Material y métodos. Se seleccionó un grupo de expertos formado por profesionales con formación clínica específica y experiencia en programas y servicios de atención al dolor. Se les proporcionó formación en seguridad de pacientes e información sobre los eventos adversos identificados, los fallos y las causas asociados. Mediante la técnica de tormenta de ideas los participantes respondieron a la pregunta: ¿qué modificaciones o mejoras habría que hacer al proceso asistencial para evitar absolutamente la aparición de cada uno de los eventos adversos? Las propuestas generadas se consensuaron y agruparon en lotes en función de su homogeneidad. Resultados. Se identificaron 456 acciones preventivas. El apartado más numeroso fue el de las modificaciones en la organización del proceso asistencial, seguido de los de las mejoras en la práctica clínica, las actividades formativas, la protocolización y la comunicación con el paciente. Conclusiones. Según el consenso de los expertos, son los cambios organizativos y las mejoras en la práctica asistencial, las intervenciones que más podrían reducir el riesgo para los pacientes en las unidades de tratamiento del dolor(AU)

Objectives. To identify preventive actions that minimise risk of patients safety in pain treatment units, and to cluster preventive actions into homogeneous groups. The current study is part of a project intended to improve patient safety in pain treatment units, and is aimed at identifying, prioritising and preventing patient safety risk. Material and methods. A group of experts was selected from professionals with a specific clinical background and experience in pain treatment units. This group was provided with information on patient safety and on known adverse events, errors and related causes. Through a brainstorming method the participants were asked: What changes or improvements would need to be undertaken to absolutely prevent the occurrence of each adverse event? The participant's proposals were analysed and grouped according to their homogeneity. Results. A total of 456 preventive actions were identified. The group that received the highest number of suggestions was the one including changes in the management of healthcare processes, followed by the group that considered improvements in clinical practice, training activities, protocols and policies, and patient communication. Conclusions. According to the consensus of the experts, management of healthcare processes and improvements in health care practices are the 2 interventions that are most likely to reduce patient safety risk in pain treatment units(AU)