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Background: In patients with advanced high-grade serous ovarian cancer (HGSOC) and prostate adenocarcinoma, the identification of somatic/germline BRCA1/2 mutations allows new therapeutic opportunities. To estimate the prevalence of somatic and germline BRCA1/2 mutations in non-mucinous high grade ovarian/fallopian tube/peritoneal extraovarian cancer (NMHGOC) and prostate adenocarcinoma. Methods: Prevalence was established by analyzing patients with NMHGOC or prostate adenocarcinoma, with a BRCA1/2 study in the tumor between 2017 and 2018. Whether a germline study had been carried out was subsequently reviewed. Results: 10 patients out of 43 (23.3%) with NMHGOC had a BRCA1/2 mutation in the tumor. 9 patients (20.9%) presented a BRCA1/2 mutation in the germline setting (2 without tumor result due to limited tissue sample). 3 patients (6.9%) had only somatic mutations. 30% of the mutations in the tumor were, therefore, somatic mutations. Of the 9 patients with prostate adenocarcinoma, 2 (22.2%) had a BRCA2 mutation in the tumor. While 1 (11.1%) had the mutation in the germline setting, 1 patient (11.1%) had only somatic mutations. Conclusion: In our series, the prevalence of somatic and germline BRCA1/2 mutations in NMHGOC is similar to that reported in the literature. Whereas somatic mutations are only present at the neoplastic tissue, the rate of mutations in the tumor is higher than in the germline setting. A more effective diagnostic and predictive strategy could be achieved with tumor BRCA analysis as the first attempt. Initial results in prostate adenocarcinoma point to the same conclusion for this tumor.

SLICE Trial Group., [Importance] Active search for pulmonary embolism (PE) may improve outcomes in patients hospitalized for exacerbations of chronic obstructive pulmonary disease (COPD)., [Objective] To compare usual care plus an active strategy for diagnosing PE with usual care alone in patients hospitalized for COPD exacerbation., [Design, Setting, and Participants] Randomized clinical trial conducted across 18 hospitals in Spain. A total of 746 patients were randomized from September 2014 to July 2020 (final follow-up was November 2020)., [Interventions] Usual care plus an active strategy for diagnosing PE (D-dimer testing and, if positive, computed tomography pulmonary angiogram) (n = 370) vs usual care (n = 367)., [Main Outcomes and Measures] The primary outcome was a composite of nonfatal symptomatic venous thromboembolism (VTE), readmission for COPD, or death within 90 days after randomization. There were 4 secondary outcomes, including nonfatal new or recurrent VTE, readmission for COPD, and death from any cause within 90 days. Adverse events were also collected., [Results] Among the 746 patients who were randomized, 737 (98.8%) completed the trial (mean age, 70 years; 195 [26%] women). The primary outcome occurred in 110 patients (29.7%) in the intervention group and 107 patients (29.2%) in the control group (absolute risk difference, 0.5% [95% CI, −6.2% to 7.3%]; relative risk, 1.02 [95% CI, 0.82-1.28]; P = .86). Nonfatal new or recurrent VTE was not significantly different in the 2 groups (0.5% vs 2.5%; risk difference, −2.0% [95% CI, −4.3% to 0.1%]). By day 90, a total of 94 patients (25.4%) in the intervention group and 84 (22.9%) in the control group had been readmitted for exacerbation of COPD (risk difference, 2.5% [95% CI, −3.9% to 8.9%]). Death from any cause occurred in 23 patients (6.2%) in the intervention group and 29 (7.9%) in the control group (risk difference, −1.7% [95% CI, −5.7% to 2.3%]). Major bleeding occurred in 3 patients (0.8%) in the intervention group and 3 patients (0.8%) in the control group (risk difference, 0% [95% CI, −1.9% to 1.8%]; P = .99)., [Conclusions and Relevance] Among patients hospitalized for an exacerbation of COPD, the addition of an active strategy for the diagnosis of PE to usual care, compared with usual care alone, did not significantly improve a composite health outcome. The study may not have had adequate power to assess individual components of the composite outcome., [Trial Registration] ClinicalTrials.gov Identifier: NCT02238639.

Background Evidence is needed to determine the role of telehealth (TH) in COPD management. Methods PROMETE II was a multicentre, randomized, 12-month trial. Severe COPD patients in stable condition were randomized to a specific monitoring protocol with TH or routine clinical practice (RCP). The primary objective was to reduce the number of COPD exacerbations leading to ER visits/hospital admissions between groups. Results Overall, 237 COPD patients were screened, and 229 (96.6%) were randomized to TH (n = 115) or RCP (n = 114), with age of 71 ± 8 years and 80% were men. Overall, 169 completed the full follow-up period. There were no statistical differences at one year between groups in the proportion of participants who had a COPD exacerbation (60% in TH vs. 53.5% in RCP; p = 0.321). There was, however, a marked but non-significant trend towards a shorter duration of hospitalization and days in ICU in the TH group (18.9 ± 16.0 and 6.0 ± 4.6 days) compared to the RCP group (22.4 ± 19.5 and 13.3 ± 11.1 days). The number of all-cause deaths was comparable between groups (12 in TH vs. 13 in RCP) as was total resource utilization cost (7912€ in TH vs. 8918€ in RCP). Telehealth was evaluated highly positively by patients and doctors. Conclusions Remote patient management did not reduce COPD-related ER visits or hospital admissions compared to RCP within 12 months.

Felipe Villar-Álvarez,1 Raúl Moreno-Zabaleta,2 Jose Joaquin Mira-Solves,3 Eduardo Calvo-Corbella,4 Salvador Díaz-Lobato,5 Fernando González-Torralba,6 Ascensión Hernando-Sanz,7 Sara Núñez-Palomo,8 Sergio Salgado-Aranda,9 Beatriz Simón-Rodríguez,10 Paz Vaquero-Lozano,11 Isabel María Navarro-Soler12On behalf of “Do not do in COPD” Working Group of the Madrid Society of Pulmonology and Thoracic Surgery (Neumomadrid)1Department of Pulmonology, IIS–Fundación Jiménez Díaz, CIBERES, UAM, 2Pulmonology, Inpatient and Noninvasive Mechanical Ventilation, Hospital Universitario Infanta Sofía, Madrid, 3Alicante-Sant Joan Health District, Alicante/Universidad Miguel Hernández Elche/REDISEC, 4Family and Community Medicine, CSU Pozuelo Estación, School of Medicine, UAM, 5Department of Pulmonology, Hospital Ramón y Cajal, Madrid, 6Pulmonology Section, Hospital Universitario del Tajo, Aranjuez, 7Department of Pulmonology, Hospital Universitario 12 de Octubre, 8C.S. Torrelaguna, 9Pulmonology Section, Hospital del Sureste, 10FisioRespiración-Respiratory Physiotherapy Unit, Escuela Universitaria Gimbernat Cantabria, 11S. Pulmonology, CEP Hnos. Sangro HGU Gregorio Marañón, Madrid, 12Calitè Research Group, Universidad Miguel Hernández de Elche, Elche, SpainBackground: To identify practices that do not add value, cause harm, or subject patients with chronic obstructive pulmonary disease (COPD) to a level of risk that outweighs possible benefits (overuse).Methods: A qualitative approach was applied. First, a multidisciplinary group of healthcare professionals used the Metaplan technique to draft and rank a list of overused procedures as well as self-care practices in patients with stable and exacerbated COPD. Second, in successive consensus-building rounds, description files were created for each “do not do” (DND) recommendation, consisting of a definition, description, quality of supporting evidence for the recommendation, and the indicator used to measure the degree of overuse. The consensus group comprised 6 pulmonologists, 2 general practitioners, 1 nurse, and 1 physiotherapist.Results: In total, 16 DND recommendations were made for patients with COPD: 6 for stable COPD, 6 for exacerbated COPD, and 4 concerning self-care.Conclusion: Overuse poses a risk for patients and jeopardizes care quality. These 16 DND recommendations for COPD will lower care risks and improve disease management, facilitate communication between physicians and patients, and bolster patient ability to provide self-care.Keywords: COPD, consensus, patient safety, quality assurance

Chronic obstructive pulmonary disease (COPD) is a significant, and largely under-diagnosed cause of morbidity and mortality worldwide.1 More long-term survivors with advanced disease led to an ageing COPD population profile with an increased level of acute exacerbations, hospitalisations and polymorbidity.2 Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article. Conflict of interest: Julio Ancochea Conflict of interest: Francisco Garcia-Rio Conflict of interest: Emma Vazquez-Espinosa Conflict of interest: Ascension Hernando-Sanz Conflict of interest: Luis Lopez-Yepes Conflict of interest: Raul Galera-Martinez Conflict of interest: German Peces-Barba Conflict of interest: Ma Teresa Perez-Warnisher Conflict of interest: Gonzalo Segrelles-Calvo Conflict of interest: Celia Zamarro Conflict of interest: Pablo Gonzalez-Ponce Conflict of interest: M. Inmaculata Ramos Conflict of interest: Jose Ignacio Conforto Conflict of interest: Syed Jafri Conflict of interest: Joan B. Soriano