[Taxanes in the adjuvant therapy of breastcancer with positive nodes: a meta-analysis]. / Taxanos en el tratamiento adyuvante del cáncer de mama con ganglios positivos: metanálisis.

INTRODUCTION: Taxanes have demonstrated high activity in the treatment of metastatic breast cancer. Based on these promising results, clinical trials were initiated to assess their efficacy in non-metastatic breast cancer both in the adjuvant and neoadjuvant setting. OBJECTIVE: To collect scientific evidence as needed for future decision making on the use of taxanes in the adjuvant therapy of breast cancer with positive nodes, and to assess the efficacy of chemotherapy regimens including a taxane using a meta-analysis. SEARCH STRATEGY: a systematic search of randomized controlled phase-Ill trials comparing poly-chemotherapy with taxanes versus other drug combinations with-out taxanes was performed. Patients were to have non-metastatic breast cancer with positive nodes, and should have received chemotherapy following surgery. The search was performed by two investigators separately. DATA COLLECTION AND ANALYSIS: data(relapses and mortality) were separately collected from clinical tri-als by two investigators to assess disease-free survival and overall survival at 5 years. Selected data underwent a meta-analysis using Peto's method. Peto odds ratio (ORp) and 95% confidence interval were calculated for each measured variable. RESULTS: Only 3 clinical trials met inclusion criteria; 7,671 patients were studied. Combined OR was ORp 0.79 (95% Cl:0.71-0.87) for disease-free survival and OR, 0.82 (95% Cl: 0.73-0.92) for overall survival. CONCLUSIONS: Chemotherapy regimens including a taxane in the adjuvant therapy setting for breast cancer with positive nodes provide a significant improvement regarding increased disease-free survival and overall survival at 5 years.

[Texas revised inventory of grief: adaptation to Spanish, reliability and validity]. / Inventario Texas Revisado de Duelo (ITRD): adaptación al castellano, fiabilidad y validez.

OBJECTIVES: To adapt into Spanish the Texas Revised Inventory of Grief (TRIG) of Faschinbaguer et al (1977, 1981) and to examine its reliability and validity. DESIGN: Two stages: a) cross-culture adaptation of a questionnaire, and b) cross-sectional study of reliability and validity. SETTING: Primary care teams in Vizcaya, north of Spain. PARTICIPANTS: 118 people who had been widowed between 3 months and 3 years before the study. MAIN MEASUREMENTS AND RESULTS: Cross-culture adaptation: the TRIG was translated from American English, then back-translated and finally compared with the version in American Spanish by Grabowski & Frantz (1993). Reliability: the Cronbach's alpha coefficients (internal consistency) of the 2 TRIG scales were 0.75 and 0.86. Factorial validity: all items except one threw saturation >0.40 on the 2 factors extracted from the varimax rotation. Validity by hypothesis: the TRIG scales showed differences (P<.05) between the grieving in terms of the expected or unexpected character of death, the place where death occurred and time elapsed since the death. The scores on the adapted TRIG were similar to scores on the American Spanish TRIG for Latins and higher than those on the original TRIG and the American Spanish TRIG for Anglo-saxons. Convergent validity: the 2 TRIG scales correlated positively (P<.05) with all the clinical scales on the Inventory of Grief Experiences of Sanders et al (1985) and García García et al (2001). CONCLUSIONS: In the evaluation of grief due to the death of the spouse, the TRIG adapted to Spanish is as reliable and valid as the original version.

Taxanos en el tratamiento adyuvante del cáncer de mama con ganglios positivos: metanálisis / Taxanes in the adjuvant therapy of breast cancer with positive nodes: a meta-analysis

Introducción: Los taxanos han demostrado tener alta actividad en el tratamiento del cáncer de mama metastásico. Basándose en estos prometedores resultados, se iniciaron ensayos clínicos para evaluar su eficacia en el cáncer de mama no metastásico, tanto como terapia adyuvante como neoadyuvante. Objetivo: Recopilar la evidencia científica necesaria para fundamentar futuras decisiones clínicas sobre el uso de los taxanos en el tratamiento adyuvante de cáncer de mama con ganglios positivos; y evaluar, mediante un metanálisis, la eficacia de los regímenes quimioterápicos que incluyan un taxano. Material y métodos: Estrategia de búsqueda: se realizó una búsqueda sistemática de ensayos clínicos aleatorizados y controlados, fase III, que compararan poliquimioterapia con taxanos, frente a otras combinaciones de fármacos quimioterápicos sin taxano. Las pacientes debían presentar cáncer de mama no metastático con ganglios positivos y haber recibido el tratamiento quimioterápico después de cirugía. La búsqueda fue realizada por dos investigadores por separado. Recolección de datos y análisis: la extracción de datos (recaídas y mortalidad) de los ensayos clínicos, fue realizada por dos investigadores por separado para valorar la supervivencia libre de enfermedad y la supervivencia global a los cinco años. Los datos seleccionados se sometieron a metanálisis utilizando el método de Peto. Para cada una de las variables medidas se calcularon las odd ratio de Peto (ORP) junto con su intervalo de confianza (IC) de 95%. Resultados: Sólo 3 ensayos clínicos cumplían los requisitos de inclusión. Se estudiaron 7.671 pacientes. La OR combinada fue ORP 0,79 (IC 95%: 0,71-0,87) en la supervivencia libre de enfermedad y en supervivencia global ORP 0,82 (IC 95%: 0,73-0,92). Conclusión: Los regímenes quimioterápicos que incluyen un taxano como tratamiento adyuvante del cáncer de mama con ganglios positivos, aportan una mejora significativa en aumento de la supervivencia libre de enfermedad y la supervivencia global a los cinco años

Introduction: Taxanes have demonstrated high activity in the treatment of metastatic breast cancer. Based on these promising results, clinical trials were initiated to assess their efficacy in nonmetastatic breast cancer both in the adjuvant and neoadjuvant setting. Objective: To collect scientific evidence as needed for future decision making on the use of taxanes in the adjuvant therapy of breast cancer with positive nodes, and to assess the efficacy of chemotherapy regimens including a taxane using a meta-analysis. Material and methods: Search strategy: a systematic search of randomized controlled phase-III trials comparing polychemotherapy with taxanes versus other drug combinations without taxanes was performed. Patients were to have non-metastatic breast cancer with positive nodes, and should have received chemotherapy following surgery. The search was performed by two investigators separately. Data collection and analysis: data (relapses and mortality) were separately collected from clinical trials by two investigators to assess disease-free survival and overall survival at 5 years. Selected data underwent a meta-analysis using Peto's method. Peto odds ratio (ORP) and 95% confidence interval were calculated for each measured variable. Results: Only 3 clinical trials met inclusion criteria; 7,671 patients were studied. Combined OR was ORP 0.79 (95% CI: 0.71-0.87) for disease-free survival and ORP 0.82 (95% CI: 0.73- 0.92) for overall survival. Conclusions: Chemotherapy regimens including a taxane in the adjuvant therapy setting for breast cancer with positive nodes provide a significant improvement regarding increased diseasefree survival and overall survival at 5 years

Inventario Texas Revisado de Duelo (ITRD): adaptación al castellano, fiabilidad y validez / Texas revised inventory of grief: adaptation to spanish, reliability and validity

Objetivo. Adaptar al castellano el Inventario Texas Revisado de Duelo (ITRD) de Faschinbaguer et al (1977, 1981) y estudiar su fiabilidad y validez. Diseño. Se realizó en 2 fases: a) adaptación transcultural de un cuestionario, y b) estudio transversal de fiabilidad y validez. Emplazamiento. Equipos de atención primaria de Vizcaya. Participantes. Un total de 118 personas que habían enviudado entre los 3 meses y 3 años anteriores al estudio. Mediciones y resultados principales. Adaptación transcultural: el ITRD en inglés americano fue traducido, retrotraducido y finalmente comparado con la versión en hispano de Grabowski & Frantz (1993). En cuanto a la fiabilidad, los coeficientes alfa de Cronbach (consistencia interna) de las 2 escalas del ITRD fueron de 0,75 y 0,86. Validez factorial: todos los ítems menos uno ofrecieron saturaciones > 0,40 a los 2 factores extraídos de la rotación varimax. Validez por hipótesis: las escalas del ITRD mostraron diferencias (p < 0,05) entre los dolientes según lo esperado o inesperado del fallecimiento, el lugar donde ocurrió la muerte y el tiempo transcurrido desde ésta; las puntuaciones del ITRD adaptado son similares a las del ITRD hispano en latinos y más elevadas que las del ITRD original y las del ITRD hispano en anglosajones. Validez convergente: las 2 escalas del ITRD correlacionaron positivamente (p < 0,05) con todas las escalas clínicas del Inventario de Experiencias en Duelo de Sanders et al (1985) y García García et al (2001). Conclusiones. En la evaluación del duelo por la muerte del cónyuge, el ITRD adaptado al castellano es tan fiable y válido como el original

Objectives. To adapt into Spanish the Texas Revised Inventory of Grief (TRIG) of Faschinbaguer et al (1977, 1981) and to examine its reliability and validity. Design. Two stages: a) cross-culture adaptation of a questionnaire, and b) cross-sectional study of reliability and validity. Setting. Primary care teams in Vizcaya, north of Spain. Participants. 118 people who had been widowed between 3 months and 3 years before the study. Main measurements and results. Cross-culture adaptation: the TRIG was translated from American English, then back-translated and finally compared with the version in American Spanish by Grabowski & Frantz (1993). Reliability: the Cronbach's alpha coefficients (internal consistency) of the 2 TRIG scales were 0.75 and 0.86. Factorial validity: all items except one threw saturation >0.40 on the 2 factors extracted from the varimax rotation. Validity by hypothesis: the TRIG scales showed differences (P<.05) between the grieving in terms of the expected or unexpected character of death, the place where death occurred and time elapsed since the death. The scores on the adapted TRIG were similar to scores on the American Spanish TRIG for Latins and higher than those on the original TRIG and the American Spanish TRIG for Anglo-saxons. Convergent validity: the 2 TRIG scales correlated positively (P<.05) with all the clinical scales on the Inventory of Grief Experiences of Sanders et al (1985) and García García et al (2001). Conclusions. In the evaluation of grief due to the death of the spouse, the TRIG adapted to Spanish is as reliable and valid as the original version

[Inventory of experiences in grief (IEG): adaptation to Spanish, reliability and validity]. / Inventario de experiencias en duelo (IED): adaptación al castellano, fiabilidad y validez.

OBJECTIVE: To adapt to Castilian the Inventory of Experiences of Grief (IEG) of Catherine Sanders et al. (1977) and study its reliability and validity. DESIGN: In two stages: cross-cultural adaptation of a questionnaire and cross-sectional study with control group. SETTING: Primary care teams in Vizcaya. PARTICIPANTS: 147 people bereaved in the period between 3 months and 3 years before the study, and 36 who had lost no direct family member in the previous 5 years. MEASUREMENTS AND MAIN RESULTS: The IEG in American English was translated, back-translated and finally reviewed by Sanders and her colleagues, whose valuation was that the Castilian version was the same as the original. Reliability: the internal consistency of each of the scales of grief on the IEG (Cronbach's alpha) ran from 0.43 to 0.85. Factor validity: the first IEG factor adapted was similar to the original one (despair, somatization, anger, blame, depersonalisation and social isolation). Discriminating validity: all the grief scales on the IEG, except anxiety in face of death, discriminated (p < 0.05) between grieving and not grieving. Validity by hypothesis: the IEG scales showed differences (p < 0.05) between the bereaved according to sex, age, place of death of the spouse and time elapsed since death. Convergent validity: all the IEG grief scales correlated positively (p < 0.05) with the scales in the Texas Revised Inventory of Grief. CONCLUSIONS: The IEG adapted to Castilian is equivalent to the original and has similar reliability and validity.

Inventario de experiencias en duelo (EID): adaptación al castellano, fiabilidad y validez / Inventory of experiences in grief: adaptation to spanish, reliability and validity

Objetivo. Adaptar al castellano el Inventario de Experiencias de Duelo (IED) de Catherine Sanders et al (1977) y estudiar su fiabilidad y validez. Diseño. En dos fases: a) adaptación transcultural de un cuestionario, y b) estudio transversal con grupo control. Emplazamiento. Equipos de atención primaria de Vizcaya. Participantes. Un total de 147 personas que habían enviudado entre los 3 meses y 3 años anteriores al estudio y 36 que no habían perdido a ningún familiar directo en los 5 años previos. Mediciones y resultados principales. El IED en inglés americano fue traducido, retrotraducido y finalmente revisado por Sanders y sus colaboradores, quienes valoraron la versión adaptada al castellano como equivalente al original. Fiabilidad: la consistencia interna de cada una de las escalas de duelo del IED (alfa de Cronbach) fue de 0,43-0,85. Validez factorial: el primer factor del IED adaptado resultó semejante al del original (desesperanza, somatización, enfado, culpa, despersonalización y aislamiento social). Validez discriminante: todas las escalas de duelo del IED, excepto la de ansiedad ante la muerte, discriminaron (p < 0,05) entre dolientes y no dolientes. Validez por hipótesis: las escalas del IED mostraron diferencias (p < 0,05) entre dolientes según sexo, edad, lugar del fallecimiento del cónyuge y tiempo transcurrido desde la muerte. Validez convergente: todas las escalas de duelo del IED correlacionaron positivamente (p < 0,05) con las del Inventario Texas Revisado de Duelo. Conclusiones. El IED adaptado al castellano es equivalente al original y tiene una fiabilidad y validez similar. (AU)

[Grief for loss of a spouse: a study with discussion groups in primary care]. / El duelo por la pérdida del cónyuge: un estudio mediante grupos de discusión en atención primaria.

OBJECTIVE: To understand the grieving process after the loss of a spouse and to find the opinion of the person grieving about the best intervention under the circumstances. DESIGN: Qualitative, with discussion groups. SETTING: Primary care. PATIENTS AND OTHER PARTICIPANTS: Widowers/widows between 30 and 70, who suffered their loss between 3 months and 2 years before the study. MEASUREMENTS AND MAIN RESULTS. The data were obtained from recordings and transcriptions, and the main ideas analysed. Two groups were defined: 11 widows between 49 and 68 years old and 6 widowers between 36 and 70. The majority of deaths had followed a previous terminal illness. Four phases of grief were found: 1) anticipated grief, 2) early grief, 3) intermediate grief and 4) delayed grief. There were differences between widows and widowers. An intervention could involve: pre-arranged appointments, home visits, and groups and, in general, spaces to be able to "talk". CONCLUSIONS: The results, in so far as they refer to the grieving process and similarities and differences of type, coincide with other authors. The participants highlighted the importance of psychological support from health workers during the last moments of the illness and the importance of this in how grieving developed. Similarly, they evaluated their own support to the dying spouse as an additional factor which helped them.

[The perceptions of family physicians of the physician-patient relation]. / Percepciones de los médicos de familia sobre la relación médico-paciente.

OBJECTIVE: To identify family doctors' (FD) perceptions of the doctor-patient relationship and the factors conditioning those perceptions. DESIGN: A descriptive crossover study. Using the technique of the discussion group, the contributions of FD from both the rural and urban areas were collected. The discussion was taped, transcribed (language and paralanguage) and analysed inductively. SETTING: Health centres in Navarra. PARTICIPANTS: 12 urban and 8 rural FD were chosen in order to include those variables (sensitivity to the question, professional field, age, years of experience and gender) which would lead to both a wide-ranging discussion and joint work. RESULTS: The FD felt they were little valued and had lost responsibilities. Patients were perceived negatively on the whole and doctors' relationship with them was lived as something unsatisfactory and full of obstacles. "Difficult" patients, along with the possibility of committing technical errors, were clearly matters of concern. Although the responsibility of external factors was emphasised, the need to reconsider their own behaviour was recognised, as was the need for special training to improve their relationships with patients. CONCLUSIONS: The attitudes of FD do not make the construction of positive relationships with patients easy and can lead into a process of serious professional and personal frustration. Neutralising this process, through a series of measures not restricted to training, is a priority in primary care development.