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Some quality indicators of proper health care in patients with colorectal cancer have been established.Our goal was to evaluate the relationship between performing of certain procedures or treatments, included as quality indicators, and some outcomes of indicators in the follow-up of colorectal cancer patients.This was a prospective cohort study of patients diagnosed with colorectal cancer that underwent surgery and were followed at 1, 2, 3, and 5 years. CT scanning, colonoscopy, chemotherapy, and radiotherapy were evaluated in relation to various clinical outcomes and PROM changes over 5 years. Multivariable generalized linear mixed models were used to evaluate their effect on mortality, complications, recurrence, and PROM changes (HAD, EQ-5D, EORTC-Q30) at the next follow-up.CT scanning or colonoscopy was related to a decrease in the risk of dying, while chemotherapy at a specified moment was related to an increased risk. In the case of recurrence, CT scanning and chemotherapy showed statistically increased the risk, while all the procedures and treatments influenced complications. Regarding PROM scales, CT scanning, colonoscopy, and radiotherapy showed statistically significant results with respect to an increase in anxiety and decrease in quality of life measured by the EORTC. However, undergoing radiotherapy at a specified moment increased depression levels, and overall, receiving radiotherapy decreased the quality of life of the patients, as measured by the EuroQol-5d.After adjustment for sociodemographic factors, comorbidities, and severity of the disease, performing certain quality indicators of proper health care in patients with colorectal cancer was related to less mortality but higher adverse outcomes.ClinicalTrials.gov Identifier: NCT02488161.

Background Seven CTX-M-27-producing Shigella sonnei strains were isolated at the University Hospital Virgen del Rocío (Seville, Spain) microbiology service from October to November 2021. Objectives To offer extensive information on the microbiological and molecular epidemiology results of the seven S. sonnei isolates and compare them with other previously documented CTX-M-27-producing S. sonnei associated with MSM transmission. Methods S. sonnei isolated from stool samples of patients with acute diarrhoea were identified through biochemical and serological typing. Whole characterization of the seven isolates was performed by sequencing with MinION Mk1C followed by genomic and molecular analysis. Results All the isolates were resistant to penicillins, cephalosporins, fluoroquinolones, cotrimoxazole and azithromycin. Sequencing showed the presence of several resistance determinants, outstanding blaCTX-M-27, azithromycin resistance genes [ermB and mph(A)], qnrB19 and mutations in the QRDRs. All isolates belonged to the same hierarchical clustering of cgMLST (HierCC) with five allele distance (HC5) scheme v1 from EnteroBase. However, they presented differences in plasmid composition, with all seven isolates harbouring IncFII, IncB/O/K/Z and ColE1-like while SH2, SH6 and SH7 had IncFIB only. Our isolates were closely related to others from Spain (HC5; 98748), Australia (HC5; 98748) and the UK (HC5; 98748), which were also associated with MSM transmission. Nevertheless, the structure of the non-chromosomal genetic elements and the genetic context of blaCTX-M-27 presented a certain variability compared with isolates from other countries and among them. Conclusions This study confirms the emergence of CTX-M-27-producing S. sonnei (ST152) associated with MSM transmission in Spain, adding it to the Europe outbreak list and reinforcing the necessity of active surveillance and control of this high-risk clone.

Seven CTX-M-27-producingTo offer extensive information on the microbiological and molecular epidemiology results of the sevenAll the isolates were resistant to penicillins, cephalosporins, fluoroquinolones, cotrimoxazole and azithromycin. Sequencing showed the presence of several resistance determinants, outstandingThis study confirms the emergence of CTX-M-27-producing

The Covid-19 pandemic has been responsible for millions of deaths worldwide. Patients with comorbidities– such as those on peritoneal dialysis (PD)– present higher morbidity and mortality than the general population. We prospectively evaluated all Chilean patients on PD (48 centres) and followed those who had Covid-19 from the beginning of the Covid-19 pandemic in Chile (March 2020) to January 2021 (start of vaccination campaign). We described demographic history, comorbidities, factors related to infection, need for hospitalisation and death due to Covid-19. During the study period, 106 adults on PD were infected by SARS-CoV-2, with a mean age of 53.1 (±16.3) and of which 53.9% were female. From that group, 54.8% required hospitalisation and 24.5% ( n = 26) died due to Covid-19. Most of the patients (63.4%) were infected at home and 22.8% during hospitalisation for other reasons. There was a significant association for Covid-19 mortality with: being ≥60 years old, diabetes, time on PD ≥5 years, need for hospitalisation and hospital-acquired infection. At 90 days of follow-up, all deaths associated to Covid-19 occurred before 40 days. We conclude that patients on PD without Covid-19 vaccination have a high mortality and need for hospitalisation associated to Covid-19. To avoid this negative outcome, it is necessary to intensify strategies to avoid contagion, especially in those ≥60 years old, with diabetes and/or ≥5 years spent on PD.

The COVID-19 pandemic is a global public health problem. Patients with end-stage renal disease on hemodialysis are at a higher risk of infection and mortality than the general population. Worldwide, a vaccination campaign has been developed that has been shown to reduce severe infections and deaths in the general population. However, there are currently limited data on the clinical efficacy of vaccinations in the hemodialysis population.A national multicenter observational cohort was performed in Chile to evaluate the clinical efficacy of anti-SARS-CoV-2 vaccination in end-stage renal disease patients on chronic hemodialysis from February 2021 to August 2021. In addition, the BNT162b2 (Pfizer-BioNTech) and CoronaVac (Sinovac) vaccines were evaluated. The efficacy of vaccination in preventing SARS-CoV-2 infection, hospitalizations, and deaths associated with COVID-19 was determined.A total of 12,301 patients were evaluated; 10,615 (86.3%) received a complete vaccination (2 doses), 490 (4.0%) received incomplete vaccination, and 1196 (9.7%) were not vaccinated. During follow-up, 1362 (11.0%) patients developed COVID-19, and 150 died (case fatality rate: 11.0%). The efficacy of the complete vaccination in preventing infection was 18.1% (95% confidence interval [CI]:11.8-23.8%), and prevention of death was 66.0% (95% CI:60.6-70.7%). When comparing both vaccines, BNT162b2 and CoronaVac were effective in reducing infection and deaths associated with COVID-19. Nevertheless, the BNT162b2 vaccine had higher efficacy in preventing infection (42.6% vs. 15.0%) and deaths (90.4% vs. 64.8%) compared to CoronaVac.The results of our study suggest that vaccination against SARS-CoV-2 in patients on chronic hemodialysis was effective in preventing infection and death associated with COVID-19.

Objective There is limited information on health service use or patient-reported outcomes when comparing the effectiveness of laparoscopic with that of open surgery. The aim was to compare the effectiveness of laparoscopic with that of open surgery up to 2 years after intervention in patients with colon cancer. Methods Prospective cohort study of patients with colon cancer who underwent surgery (laparoscopic or open surgery) between June 2010 and December 2012, at 22 hospitals. Main outcomes of the study were mortality, complications, reoperation, readmission, and patient-reported outcome measures (PROMs), as measured using the Hospital Anxiety and Depression Scale, Duke-UNC, EuroQol-5D, and European Organisation for Research and Treatment of Cancer-Q30 and Q29 at baseline, and 30 days and 1 and 2 years after surgery. Multivariable multilevel logistic regression and generalized linear models were used in analyses after adjusting for specific propensity scores developed for each outcome and time point. Results In the multivariable analysis, the complication rates up to 30 days (infectious, surgical, and medical) and 1 year (surgical), and readmission rate at 30 days and at 2 years were higher among patients who underwent open surgery than among those who underwent laparoscopic surgery. There were no differences between the two surgical approaches in all other parameters assessed and in changes of all PROMs. Conclusions Though in most outcomes both surgical approaches provide similar results up to 2 years after intervention, still the rates of some complications and readmission, mainly up to 30 days, are higher in open surgery. ClinicalTrials.gov Identifier NCT02488161 .

Background The aim of this study was to identify predictors of mortality in elderly patients undergoing colorectal cancer surgery and to develop a risk score. Methods This was an observational prospective cohort study. Individuals over 80 years diagnosed with colorectal cancer and treated surgically were recruited in 18 hospitals in the Spanish National Health Service, between June 2010 and December 2012, and were followed up 1, 2, 3, and 5 years after surgery. Sociodemographic and clinical data were collected. The primary outcomes were mortality at 2 and between 2 and 5 years after the index admission. Results The predictors of mortality 2 years after surgery were haemoglobin ≤ 10 g/dl and colon locations (HR 1.02; CI 0.51–2.02), ASA class of IV (HR 3.55; CI 1.91–6.58), residual tumour classification of R2 (HR 7.82; CI 3.11–19.62), TNM stage of III (HR 2.14; CI 1.23–3.72) or IV (HR 3.21; CI 1.47–7), LODDS of more than − 0.53 (HR 3.08; CI 1.62–5.86)) and complications during admission (HR 1.73; CI 1.07–2.80). Between 2 and 5 years of follow-up, the predictors were no tests performed within the first year of follow-up (HR 2.58; CI 1.21–5.46), any complication due to the treatment within the 2 years of follow-up (HR 2.47; CI 1.27–4.81), being between 85 and 89 and not having radiotherapy within the second year of follow-up (HR 1.60; CI 1.01–2.55), no colostomy closure within the 2 years of follow-up (HR 4.93; CI 1.48–16.41), medical complications (HR 1.61; CI 1.06–2.44), tumour recurrence within the 2 years of follow-up period (HR 3.19; CI 1.96–5.18), and readmissions at 1 or 2 years of follow-up after surgery (HR 1.44; CI 0.86–2.41). Conclusion We have identified variables that, in our sample, predict mortality 2 and between 2 and 5 years after surgery for colorectal cancer older patients. We have also created risks scores, which could support the decision-making process. Trial registration ClinicalTrials.gov, NCT02488161.

REDISSEC-CARESS/CCR group., [Introduction] Few studies have been conducted to establish the relationship between colorectal cancer screening programmes and survival adjusting by stage and, to determine whether there are differences, at a biological level, between the tumours of asymptomatic and symptomatic patients. Accordingly, the aim of this study is to evaluate clinical, biological and survival differences between symptomatic colorectal tumours and those detected by screening., [Study method] A prospective cohort study was performed of patients subjected to surgical intervention during the period 2010–2012, at different hospitals in Spain. In every case, clinical, pathological, biological and survival-related variables were obtained., [Results] A total of 2634 patients from the CARESS-CCR cohort were analysed; of these, 220 were diagnosed through screening. The asymptomatic patients were younger, had a higher Body Mass Index (BMI), a lower degree of perineural invasion and a less advanced T stage and nodular stage, and the tumour was frequently located on the right side of the colon. All of these differences were statistically significant. The serum tumour marker carbohydrate antigen 19.9 (CA 19.9) was found more frequently in the symptomatic patients (p, [Conclusions] The detection method employed influenced the survival of patients with colorectal cancer and there were no significant biological differences between the study groups., This research was partially supported by grants from REDISSEC (RD12/0001/0010 and RD16/0001/0006), Instituto de Salud Carlos III (PI 09/00910, PI 13/00013, PI 18/01181) and the European Regional Development Fund.

Purpose The delayed diagnosis of colorectal cancer (CRC) may be attributable to sociodemographic characteristics, to aspects of tumour histopathology or to the functioning of the health system. We seek to determine which of these factors most influences prolonged patient-attributable delay (PPAD) in the diagnosis and treatment of CRC. Materials and methods A prospective, multicentre observational study was conducted in 22 Spanish hospitals. In total, 1,785 patients were recruited to the study between 2010 and 2012 and underwent elective or urgent surgery. PPAD is considered to occur when the time elapsed between a patient presenting the symptom and him/her seeking attention from the primary care physician or hospital emergency department exceeds 180 days. A bivariate analysis was performed to assess differences in variables segmented by tumour location and patient delay. Multivariate logistic regression analysis was performed on the outcome variable, PPAD. Results The rate of PPAD among this population was 12.1%. PPAD was significantly associated with altered bowel rhythm (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.02 to 1.83) and with adenocarcinoma histology, in comparison with mucinous adenocarcinoma (OR, 2.03; 95% CI, 1.11 to 3.71). Other sociocultural factors and clinicopathological features were not independent predictors of PPAD. Conclusion Many patients do not consider altered bowel rhythm an alarming symptom, warranting a visit to the doctor. PPAD could be reduced by improving health education, raising awareness of CRC-related symptoms.

Objective To identify factors associated with early, intermediate or late recurrence colon cancer recurrence. Methods A total of 1,732 consecutive patients with colon cancer were recruited and followed for a period of 5 years. Recurrence at 1 year (early), from 1 to 2 (early), from 2 to 3 (intermediate) and from 3 to 5 years (late) was the main outcome measures. Results Predictors of early recurrence (AUC (95% CI):0.74 (0.70–0.78) were as follows: TNM stage II and III, more than one type of invasion, haemoglobin

Objective The aim of this study was to explore the association between baseline social support, functional status, and change in health-related quality of life (HRQoL) in colorectal cancer patients and change in anxiety and depression measured by Hospital Anxiety and Depression Scale (HADS) at 1 year after surgery. Methods Consecutive patients who were due to undergo therapeutic surgery for the first time for colon or rectal cancer in 9 hospitals in Spain were eligible for the study. Patients completed the following questionnaires before surgery and 12 months afterward: 1 HRQoL instrument, the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire; a social support questionnaire, the Duke-UNC Functional Social Support Questionnaire; the Barthel Index, to assess functional status; the HADS, to assess anxiety and depression; and questions about sociodemographic information. General linear models were built to explore the association between social support, functional status, and change in HRQoL and changes in anxiety and depression 12 months after surgery. Results A total of 947 colorectal cancer patients took part in the study. Patients' functional status, social support, and change in HRQoL were associated with changes in anxiety and depression. Greater social support and improvements in physical, cognitive, and social functioning and in insomnia resulted in improvements in anxiety and depression. No functionally independent patients were associated with lesser improvements in anxiety and depression. Conclusions Colorectal cancer patients who have more social support, are functionally independent and have higher improvements in HRQoL may have better results in anxiety and depression at 1 year after surgery, adjusting for age, gender, location, occupation, and baseline HADS scores.

To identify and validate risk factors that contribute to prolonged length of hospital stay (LOS) in patients undergoing resection for colorectal cancer. This prospective cohort study included 1955 patients admitted to 22 hospitals for primary resection of colorectal cancer. Multivariate analyses were used to identify and validate risk factors, randomizing patients into a derivation and a validation cohort. Multiple correspondence and cluster analysis were performed to identify clinical subtypes based on LOS. The strongest independent predictors of prolonged LOS were postoperative reintervention, surgical site infection, open surgery, and distant metastasis. The multiple correspondence and cluster analysis provided three groups of patients in relation to prolonged LOS: patients with the longest LOS included the highest percentage of patients with open surgery, distant metastasis, deep surgical site infections, emergency admissions, additional diagnostic factors, and highly contaminated surgical sites. Patients with prolonged LOS (> 14 days) were more likely to develop adverse outcomes within 30 days after discharge. Patients undergoing resection of colorectal cancer cluster into different groups based on LOS of the index admission. Those with prolonged LOS were more likely to develop adverse outcomes within 30 days after discharge. Some of the strongest independent predictors of prolonged LOS, such as surgical infections or open surgery, could be modified to reduce LOS and, in turn, other adverse outcomes. NCT02488161

The great variability in the clinical presentation of Fabry Disease (FD), the difficulties for its diagnosis, and the availability of several alternatives for its treatment, are a great challenge for the professionals who treat patients with FD, that justify the elaboration of an evidence based clinical practice guideline (CPG) to help decision-making in the management of Fabry patients. METHODS: We applied both the guidances from NICE guideline development methods and GUIASALUD (Spanish NHS Guideline Methods). We incorporated GRADE methodology (Grading of Recommendations Assessment) for the evaluation of quality of scientific evidence and the development and weighing of recommendations. For the final elaboration of these recommendations, a structured consensus process was carried out with a panel of 9 experts proposed by different scientific societies, research centers and patients' associations in two rounds using the Delphi-RAND method. Finally, the proposed guideline was reviewed by stakeholders (pharma industries, scientific societies and patient associations). The guideline maintains a living process for annual updating. RESULTS: thirty-two PICO clinical questions were considered, gathered in 9 different steps of the process of care. Tables were prepared for the synthesis and evaluation of the quality of the evidence for each of the questions. Regarding the quality of the evidence, balance between benefits and risks, values and preferences of patients, equity and use of resources were considered. The FD-Guideline contains 92 specific recommendations for the management of FD including chapters on when to suspect the disease or how to support social and non-medical outcomes for patients and families. CONCLUSIONS: An evidence based CPG about Fabry disease is now available for both health care workers involved in this disease and patients.

Background The aim of this study was to explore the association of social support received, and functional and psychological status of colorectal cancer patients before surgery with changes in health-related quality of life (HRQoL) outcomes measured by EORTC QLQ-C30 at 1-year post-intervention. Methods Consecutive patients that were because of undergo therapeutic surgery for the first time for colon or rectum cancer in nine hospitals in Spain were eligible for the study. Patients completed questionnaires before surgery and 12 months afterwards: one HRQoL instrument, the EORTC QLQ-C30; a social network and social support questionnaire, the Duke-UNC Functional Social Support Questionnaire; the Hospital Anxiety and Depression Scale, to assess anxiety and depression; and the Barthel Index, to assess functional status; as well as questions about sociodemographic information. General linear models were built to explore the association of social support, functional status, and psychological variables with changes in HRQoL 12 months after intervention. Results A total of 972 patients with colorectal cancer took part in the study. Patients' functional status, social support, and anxiety and depression were associated with changes in at least one HRQoL domain. The higher functional status, and the higher social support, the more they improved in HRQoL domains. Regarding anxiety and depression, the more anxiety and depression patients have at baseline, less they improve in HRQoL domains. Conclusions Patients with colorectal cancer who have more social support and no psychological distress may have better results in HRQoL domains at 1 year after surgery. Copyright © 2015 John Wiley & Sons, Ltd.

The goal of this study was to compare the effectiveness of laparoscopic with that of open surgery up to 2 years after intervention in patients with rectal cancer. This is a prospective cohort study of patients with rectal cancer who underwent surgery (laparoscopic or open) between June 2010 and December 2012 in 22 acute hospitals. Main outcomes were mortality, complications, reoperation, readmission, and patient-reported outcome measures (PROMs), as measured using the EuroQol-5D (EQ-5D), European Organisation for Research and Treatment of Cancer (EORTC) QLQ-Q30 and Q29, the Barthel Index (BI), and the Duke-UNC Functional Social Support Questionnaire at baseline, 1 year, and 2 years after surgery. Multivariable multilevel logistic regression and generalized linear models were used in the analyses after adjusting for specific propensity scores developed for each outcome and time point. In the multivariable analysis, rates of some medical complications after surgery during admission (renal failure and paralytic ileus) and infectious (urinary tract infection, septic shock, and localized intra-abdominal infection) and at 1 year (renal and heart failure) were higher among patients who underwent open surgery than among those who underwent laparoscopic surgery. There were no differences between the two surgical approaches in all other parameters assessed at the different time points or in all PROMs evaluated. Laparoscopic surgery and open surgery provide quite similar results in patients with rectal cancer up to 2 years after intervention in most outcomes, though the rates of certain medical and infectious complications at admission and up to 1 year after the intervention were higher in open surgery.

Background Acute kidney injury (AKI) has increasingly been recognized as an important public health issue due to its rising frequency, its associations with early and late adverse outcomes and its economic burden. Methods Given the importance of determining the available resources to address this serious issue, the AKI Committee of SLANH conducted a survey to obtain information about infrastructure, human resources and equipment devoted to the treatment of AKI in Latin America Results A total of 246 units from 14 countries participated in the survey, the majority of them pertaining to nephrology divisions in teaching hospitals. Intermittent hemodialysis was universally performed by all of the units, and less frequently, slow extended dialysis (40%) and continuous renal replacement therapy (23%) were performed. Seventy-nine units (30%) perform peritoneal dialysis, but only 51 (19%) of them reported having treated at least 1 patient with this technique in the last 3 months pre-survey. The vast majority of the units reported adequate water treatment and use of modern filter membranes. Most of the patients received renal replacement therapy (RRT) in the intensive care unit. Specific causes of AKI were reported in different frequencies, with a heterogeneous pattern among the countries. Septic abortion, hemolytic-uremic syndrome, community-acquired diarrhea and leptospirosis were the etiologies most frequently associated with AKI. Conclusions To our knowledge, this report was the first available study of the equipment and human resources utilized for RRT in AKI patients in Latin America.

Objective To evaluate the clinical outcome after aPL (antiphospholipid antibodies) disappearance in primary APS patients. Methods From a cohort of 70 patients with primary APS, we selected patients with positive aPL determinations at onset and ≥ 2 subsequent negative aPL determinations during the last 5 years. To corroborate the immunologic profile, we determined IgG/IgM aCL antibodies, IgG/IgM antiβ2GPl, anti-annexin A5 antibodies and lupus anticoagulant (LA). All patients continued treatment with oral anticoagulants. Clinical data and aPL determinations at onset/after disappearance were obtained. Statistical analysis: descriptive statistics and Kaplan-Meier analysis. Results We found 24 patients with persistently negative aPL, including the last immunologic profile, 17 females, 7 males, mean age 51.7, disease evolution 16.3 years, mean of 4 aPL previous positive determinations. aCL was positive at onset in 87.5%, 29% had double aPL positivity at onset (aCL/LA). Deep venous thrombosis (DVT) and ischemic stroke in 33% and pulmonary embolism in 12.5% were the most frequent manifestations at onset. INR range: 2–3. Time with aPL positive 109.4 ± 80.7 months. After 60 months of follow-up since aPL disappearance, 45.8% of patients presented thrombosis recurrence, DVT in 9 patients, ischemic stroke in 1, pulmonary artery hypertension in 1. Other non-thrombotic APS manifestations were chronic ulcers in lower extremities and severe thrombocytopenia. Conclusions This study suggest, that in primary APS, persistent negative aPL profile is not an indication to interrupt oral anticoagulant therapy. However, there is a subset of patients that remained asymptomatic. Other studies are necessary in order to elucidate this controversy.

La peritonitis fúngica es una complicación mayor de la diálisis peritoneal, con una alta mortalidad asociada y la mayoría de los sobrevivientes presentan una alta tasa de abandono de diálisis peritoneal como terapia de reemplazo renal. Se presenta un caso de peritonitis fúngica por un agente infrecuente. Mujer de 83 años, diabética con múltiples episodios de peritonitis bacteriana asociada a fallas técnicas en la ejecución de diálisis peritoneal automatizada, ingresa por cuadro clínico de dolor abdominal y líquido peritoneal turbio. Se confirmó la presencia de Rhodotorula mucilaginosa en líquido peritoneal mediante MALDI-TOF. Fue tratada con retiro del catéter y posaconazol oral por 14 días, presentando una evolución favorable.

// Irene Zarcos-Pedrinaci 1, 11 , Alberto Fernandez-Lopez 2 , Teresa Tellez 1, 11 , Francisco Rivas-Ruiz 1, 11 , Antonio Rueda A 3, 11 , Maria Manuela Morales Suarez-Varela 4 , Eduardo Briones 5 , Marisa Bare 6, 11 , Antonio Escobar 7, 11 , Cristina Sarasqueta 8, 11 , Nerea Fernandez de Larrea 9, 11 , Urko Aguirre 10, 11 , Jose Maria Quintana 10, 11 , Maximino Redondo 1, 11 and On Behalf of the CARESS-CCR Study Group 1 Research Unit, Agencia Sanitaria Costa del Sol, Marbella, Spain 2 Servicio de Cirugia, Agencia Sanitaria Costa del Sol, Marbella, Spain 3 Servicio de Oncologia Medica, Agencia Sanitaria Costa del Sol, Marbella, Spain 4 Unit of Public Health, Hygiene and Environmental Health, Department of Preventive Medicine and Public Health, Food Science, Toxicology and Legal Medicine, University of Valencia, CIBER-Epidemiology and Public Health (CIBERESP), Valencia, Spain 5 Public Health Unit, Distrito Sanitario Sevilla, Consorcio de Investigacion Biomedica de Epidemiologia y Salud Publica, Madrid, Spain 6 Clinical Epidemiology and Cancer Screening, Corporacio Sanitaria Parc Tauli, Sabadell, Spain 7 Research Unit, Hospital Universitario Basurto, Bilbao, Spain 8 Research Unit, Donostia University Hospital, San Sebastian, Spain 9 Area of Environmental Epidemiology and Cancer, National Epidemiology Centre, Instituto de Salud Carlos III, Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiologia y Salud Publica, CIBERESP), Madrid, Spain 10 Research Unit, Hospital Galdakao-Usansolo, Galdakao, Spain 11 Red de Investigacion en Servicios de Salud en Enfermedades Cronicas – REDISSEC, Spain Correspondence to: Maximino Redondo, email: mredondo@hcs.es Keywords: colorectal, cancer, delay, treatment, education Received: May 30, 2016 Accepted: November 12, 2016 Published: November 24, 2016 ABSTRACT A prospective study was performed of patients diagnosed with colorectal cancer (CRC), distinguishing between colonic and rectal location, to determine the factors that may provoke a delay in the first treatment (DFT) provided. 2749 patients diagnosed with CRC were studied. The study population was recruited between June 2010 and December 2012. DFT is defined as time elapsed between diagnosis and first treatment exceeding 30 days. Excessive treatment delay was recorded in 65.5% of the cases, and was more prevalent among rectal cancer patients. Independent predictor variables of DFT in colon cancer patients were a low level of education, small tumour, ex-smoker, asymptomatic at diagnosis and following the application of screening. Among rectal cancer patients, the corresponding factors were primary school education and being asymptomatic. We conclude that treatment delay in CRC patients is affected not only by clinicopathological factors, but also by sociocultural ones. Greater attention should be paid by the healthcare provider to social groups with less formal education, in order to optimise treatment attention.

El propósito de esta investigación es reconstruir los discursos publicados en la prensa ecuatoriana alrededor de la libertad de expresión, durante el periodo previo a la aprobación de la Ley Orgánica de Comunicación, en 2013. Para el efecto, se seleccionaron artículos de opinión publicados en cuatro medios impresos de comunicación del Ecuador (El Telégrafo, El Comercio, El Universo y El Diario). Uno público, por ser el único de su índole y características; y tres privados, tomando en consideración su ubicación geográfica; de esta manera se busca mostrar distintos espacios de representación en la opinión pública. Se estudiarán, por tanto, los discursos para determinar las características del conflicto simbólico alrededor de la noción de libertad de expresión., The purpose of this research is to reconstruct the discourses published in the Ecuadorian press around freedom of expression, during the period prior to the approval of the Organic Law of Communication, in 2013. For this purpose, articles of opinion published in four print media of Ecuador (El Telégrafo, El Comercio, El Universo and El Diario) were selected. One public, for being the only one of its nature and characteristics; and three private ones, taking into account their geographical location; in this way, it seeks to show different spaces of representation in public opinion. Speeches will therefore be studied to determine the characteristics of the symbolic conflict around the notion of freedom of expression., Facultad de Periodismo y Comunicación Social

Resumen En las ultimas decadas, las politicas sanitarias de los paises desarrollados y los profesionales estan orientando sus actividades hacia el ciudadano como eje del sistema sanitario. Los ciudadanos, a su vez, demandan un papel activo en la toma de decisiones relacionadas con su salud. En este contexto, el desarrollo y la utilizacion de guias de practica clinica (GPC) se estan orientando tambien como instrumento de encuentro entre politicas, ciudadanos y profesionales, lo que plantea no pocas dificultades metodologicas y operativas. El objetivo de este trabajo es proporcionar pautas generales que ayuden a los distintos actores en la incorporacion de los pacientes para el desarrollo de las GPC y adaptarlas a una version de pacientes (GPC-P). Se ha realizado una revision estructurada de documentos metodologicos sobre GPC y documentos orientados a la elaboracion de GPC-P o similares. Tras la sintesis de informacion, se proponen tres areas de desarrollo (contenidos, diseno y evaluacion) y dos ambitos en la participacion del paciente en GPC: como un miembro mas del grupo que elabore la guia y/o como miembro del grupo de la elaboracion de la GPC-P. El proceso de participacion de ciudadanos no es sencillo, requiere planificacion y sensibilidad de los implicados, pero no cabe duda que anade valor en la implantacion de las GPC.

Fungal peritonitis is a major complication of peritoneal dialysis associated with high mortality. Most survivors have a high rate of abandonment of peritoneal dialysis. We report a case of fungal peritonitis due to an unusual agent. An 83 year-old woman, with a history of type 2 diabetes mellitus and multiple episodes of bacterial peritonitis associated to technical flaws in the implementation of automated peritoneal dialysis, was admitted due to abdominal pain and cloudy peritoneal fluid. Rhodotorula mucilaginosa was identified in the peritoneal fluid by MALDI-TOF. She was treated with catheter removal and oral posaconazole for 14 days showing clinical resolution and non-recurrence.

Objective: To analyze registry quality in centralized cytostatic therapy units in Andalusian hospitals, and the availability of data to analyze the use of these drugs. Method: An ad hoc questionnaire was designed using variables related to information coverage on patients and their treatments, data processing extent, and organization. Questionnaires were completed in September 2005 by surveying people responsible for chemotherapy in all 19 pharmacy departments in Andalusian hospitals that treat oncologic patients. Results: Response rate was 100%, but one department had no centralized cytostatic therapy unit. Centralized preparation coverage was 89% for the day hospital, 84% for inpatients, 79% for hematologic patients, and 69% for pediatric patients. Registries are computerized in only 13 hospitals (68%) with a variety of software programs. Temozolamide and capecitabine dispensation has a separate registry in 68% and 42% of cases, respectively. Patient name, and cytostatic name and dosage are the only data recorded in all instances, while protocol name is only recorded in 47%, and diagnosis, staging, and TNM categorization in 58%, 31%, and 16% of cases, respectively. Conclusions: There is great variability regarding information systems for cytostatic use management, and a relevant shortage of patient data available for prescription use and adaptation studies.

Introduccion y objetivos La practica clinica en la angina inestable (AI) no esta siempre basada en la major evidencia disponible. Las guias clinicas tienen el potencial de mejorar la calidad de la asistencia. Hasta el momento no hay ningun ensayo clinico aleatorizado para evaluar diversas estrategias de implantacion de guias en el sistema sanitario publico espanol. El objetivo de este articulo es comparar la efectividad de una estrategia multifactorial de implantacion de una guia clinica (sesiones formativas interactivas, procesos de consenso local) en la AI frente a una estrategia de diseminacion pasiva. Pacientes y metodo El estudio se realizo en 10 unidades de 3 hospitales universitarios de Sevilla. Participaron 153 especialistas (cardiologos, internistas) y sus pacientes admitidos por AI. La intervencion se realizo de enero a abril de 1998. La recogida retrospectiva de datos se hizo en julio de 1999, tanto para los episodios preintervencion como postintervencion atendidos desde enero a octubre de 1997 y de septiembre 1998 a junio de 1999, respectivamente. En cuanto al diseno, fue un ensayo clinico aleatorizado por grupos, antes-despues, pragmatico. Los desenlaces fueron: cumplimiento de las recomendaciones de una guia sobre la utilizacion de la angiografia coronaria, pruebas de estres y valoracion de fraccion de eyeccion. Resultados La estrategia multifactorial comparada con la pasiva se asocio con una mejoria absoluta en la adecuacion de uso de angiografia coronaria y de pruebas de estres del 11% (intervalo de confianza [IC] del 95%, 0,85-21,1; p = 0,03). Para la valoracion de la fraccion de eyeccion no se encontro asociacion: mejoria absoluta del 1,1% (IC del 95%, −15,9 a 18,1; p = 0,88). Conclusiones Nuestros resultados muestran que una intervencion combinada de sesiones formativas interactivas con procesos de consenso de local administrada a unidades asistenciales de facultativos puede mejorar la adecuacion de uso de la angiografia coronaria y de las pruebas de estres.

Objetivos Estimar el grado de implantacion de la rehabilitacion cardiaca en el Sistema Nacional de Salud, describir las caracteristicas de los programas y las opiniones de sus responsables sobre su desarrollo. Pacientes y metodo Se identificaron las unidades de rehabilitacion cardiaca a partir de diversas fuentes. Se envio un cuestionario postal a sus responsables, con preguntas sobre cobertura, recursos, actividades y servicios, seleccion de pacientes, y opiniones. Resultados Se localizaron 12 hospitales publicos que llevaban a cabo rehabilitacion cardiaca. Como media, esta se oferta al 53% de los pacientes elegibles. Todas las unidades incluyen a pacientes con infarto de miocardio, un 64% con insuficiencia cardiaca y un 60% pacientes de alto riesgo. Un 10-19% de los pacientes son mujeres. Los medicos mas implicados son los cardiologos; los profesionales no medicos que mas participan son los fisioterapeutas, y un 64% de las unidades cuenta con psicologo. La realizacion de la fase II es generalizada, y la fase III se realiza mas en unidades coordinadas con centros extrahospitalarios (45%). Ademas del ejercicio fisico, todas las unidades ofrecen consejo sobre la enfermedad y los factores de riesgo, y el 73%, apoyo psicologico. Las principales motivaciones mencionadas para hacer rehabilitacion son su caracter preventivo y la eficacia, y las principales barreras, la falta de medios y apoyo. Se cree que la atencion primaria puede desempenar un papel importante. Conclusiones La rehabilitacion cardiaca esta escasamente implantada en el sistema sanitario publico. Las mayores diferencias entre programas son la inclusion de pacientes de alto riesgo y con diagnosticos distintos del infarto, la coordinacion con centros extrahospitalarios y realizacion de fase III.

Fundamento. Unas mayores posibilidades de quimioterapia en pacientes avanzados obliga a seleccionar los estudios mas apropiados. Presentamos una propuesta practica basada en la eficacia y costeefectividad. Metodo. A partir de variables de eficacia, calidad de vida y de diseno del estudio es posible clasificarlo. Los costes diferenciales entre esquemas, por mes de supervivencia y por paciente vivo al ano sirven para estimar el coste-efectividad. Resultados. Evaluamos 5 esquemas de uso frecuente en ovario, mama, pulmon, colon y cerebro que producen resultados discretamente positivos y mas costosos: cada mes de aumento de la supervivencia mediana oscila entre los 1.500 y los 25.500 euros adicionales. Conclusion. La propuesta es aplicable y mejorara la toma de decisiones.

Resumen La densitometria dual de doble energia de rayos x (DEXA) permite una medida directa y no invasiva de la densidad mineral osea (BMD). El objetivo del estudio fue proporcionar recomendaciones para el uso apropiado de la densitometria en nuestro hospital para conseguir un diagnostico certero y un tratamiento adecuado. Una comision interdisciplinaria realizo una revision sistematica de la bibliografia. Beneficios, danos y costes El diagnostico temprano de la osteoporosis a traves de la densitometria osea minimiza lesiones, mejora la calidad de vida y reduce el coste personal y social asociado a esta patologia. Como inconvenientes tiene la exposicion a radiaciones ionizantes y el coste. Los inconvenientes y el coste del uso apropiado de la DEXA son minimos comparados con el coste de la osteoporosis. Recomendaciones La densidad mineral osea debe evaluarse solo cuando sea necesario para el manejo clinico del paciente. DEXA es el mejor metodo para medir la densidad mineral osea. Salvo que se sospeche una perdida de masa osea acelerada la DEXA no debe repetirse antes de los 2 anos para monitorizar tratamientos. Las medidas y los informes de resultados deben estandarizarse.

Purpose To develop and validate a clinical score to predict visual acuity (VA) and functional changes after phacoemulsification on the basis of readily obtainable preoperative history data and patient assessment. Design Prospective follow-up study. Participants A sample of 5512 patients on waiting lists for phacoemulsification at 17 hospitals in Spain. Methods Data were obtained at the baseline examination from the 5512 patients. The patients were divided randomly into 2 subgroups: derivation (n = 3285; 60%) and validation (n = 2227; 40%). The preoperative predictors of postoperative gains in VA and visual function index 14 (VF-14) were determined by multivariate logistic regression analysis and implemented using a prediction score. Main Outcome Measures Probability of postoperative improvement in VA and VF-14 scores. The cutoff points were established for each outcome on the basis of the minimal clinically important difference values. Results The predictive variables for VA gain were the baseline VA, patient age, ocular comorbidity, and surgical complexity. Regarding the VF-14, the predictive factors were the preoperative VF-14, the eye with the better VA, and the surgical complexity. In the multivariate logistic model in the derivation sample, the final VA and VF-14 scores ranged from 0 to 44 and from 0 and 24, respectively. Receiver operating characteristic curves were developed in the derivation and validation samples, and no statistical significance was found when their areas under the curve were compared. Areas under the curve ranged from 65% to 80%. Both scores had a positive predictive value from 74% to 85%. Conclusions Newly developed and validated clinical prediction scores may assist physicians and patients in decision making about the expected outcomes and benefits of cataract surgery. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Objectives: The aim of this study was to describe the characteristics of the introduction and diffusion of health technology assessment (HTA) in Spain.Methods: A survey to summarize the evolution of HTA was sent to representatives of different HTA initiatives in Spain.Results: HTA was introduced in the late 1980s. The main factors were the trend to an increase in healthcare expenditure, concerns regarding efficiency in providing health care, as well as in the level of rationality introducing high technology. Spain has direct (i.e., regulation) and indirect (i.e., payment systems, evidence-based programs, HTA) mechanisms to control health technologies. A recent high priority regulation has established the need of HTA to decide the introduction of a new health technology in the lists of public healthcare coverage, although similar regulations existed in the past and were scarcely implemented. HTA initiatives started at the regional government level. Its introduction followed a progressive pattern among regions. In the beginning, resources were scarce and expertise limited, with work done at intramural level. With time, expertise increase, and promotion of commissioned work was implemented. HTA knowledge transfer in the healthcare system has been carried out through courses, publications, and commissioned research. Currently, there are seven HTA units/agencies, which coordinate their work.Conclusions: HTA in Spain is in its maturity. Facing the unavoidable change of health care environment over time, HTA is also evolving and, currently, there is a trend to broaden the areas of influence of HTA by devolving capacity to hospitals and applying principles to very early phases of health technology development, under the umbrella of regional HTA units/agencies. However, there are two main challenges ahead. One is to have a real impact at the highest level of healthcare policy coordination among Spanish regions, which is done at the Central Ministry of Health. The other is to avoid the influence of political waves in the level of recognition of HTA at the policy decision-making level and to have an adequate and stable funding of HTA initiatives.