Fortalecimiento de la musculatura respiratoria en mujeres mayores en Atención Primaria / Training respiratory muscle in elderly women in primary care

ANTECEDENTES Y OBJETIVO: El envejecimiento implica una reducción de la masa muscular y la fuerza muscular. El objetivo del estudio fue valorar la efectividad de un protocolo de ejercicios específicos de facilitación neuromuscular propioceptiva (FNP) sobre la fuerza muscular respiratoria. MATERIAL Y MÉTODO: Estudio experimental con 69 mujeres mayores no institucionalizadas y voluntarias participantes en un programa de ejercicio físico. Fueron divididas aleatorizadamente en 2 grupos. El grupo intervención recibió un protocolo de tratamiento respiratorio específico basado en metodología de la FNP con 2 sesiones semanales de 50 min durante 8 semanas. El grupo control no recibió intervención adicional. Se evaluó la fuerza de la musculatura respiratoria mediante la presión inspiratoria máxima (PIM) y la presión espiratoria máxima (PEM). RESULTADOS: Se registró un aumento estadísticamente significativo (p < 0,001) y clínicamente relevante en el grupo de intervención en la PIM 13,84mb (IC 95%: 9,017-18,671) y la PEM 25,69 mb (IC 95%: 20,373-31,002). Se obtuvieron diferencias con significación estadística entre los grupos: PIM 20,00mb (IC 95%: 11,13-28,88; p < 0,001) y PEM 27 mb (IC 95%: 19,75-35,012; p < 0,001). CONCLUSIÓN: El trabajo muscular respiratorio específico con FNP mejoró las presiones respiratorias, lo que puede mejorar la fuerza y la función respiratorias en adultos mayores. Este tratamiento puede utilizarse como una intervención preventiva para minimizar las implicaciones del envejecimiento sobre la pérdida de masa y fuerza muscular

BACKGROUND AND OBJECTIVE: Aging results in reduced muscle mass and strength. The aim was to evaluate the effectiveness of a proprioceptive neuromuscular facilitation (PNF) exercise protocol on respiratory muscle strength. MATERIAL AND METHODS: An experimental study of 69 elderly, non-institutionalized female volunteers who participated in a physical exercise programme. They were randomly divided into 2 groups. The intervention group performed a specific respiratory treatment protocol using the PNF technique. The control group did not receive an additional intervention. The PNF treatment consisted of 2 weekly sessions lasting 50 minutes over an 8-week time period. Respiratory muscle strength was measured for both groups by maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). RESULTS: There was a statistically significant (P <. 001) and clinically relevant increase in the intervention group in MIP 13.84 mb (95% CI: 9.017-18.671) and MEP 25.69 mb (95%CI: 20.373-31.002). There was also a statistically significant difference between groups: MIP 20.00 mb (95% CI: 11.13-28.88; P < .001) and PEM 27mb (95% CI: 19.75-35.012; P < .001). CONCLUSIONS: The PNF respiratory treatment improved respiratory pressures, which may improve respiratory strength and function in older adults. This treatment can be used as prevention to minimize the loss of muscle mass and strength as a result of aging

Oncologist's knowledge and implementation of guidelines for breakthrough cancer pain in Spain: CONOCE study

Purpose. Breakthrough cancer pain (BTcP) has been shown to be a prevalent and poor prognostic factor for oncologic patients, which remain under diagnosed and undertreated. In 2012, the Spanish Society of Medical Oncology (SEOM) published a clinical practice guideline (CPG) for the treatment of cancer pain which specifically addressed the management of BTcP. Methods. Fundación ECO designed a qualitative study using an Internet-based survey to investigate the attitudes toward, compliance with, and use of SEOM Guideline. Results. A total of 83 oncologists with a mean experience of 13 years responded. Overall, 82% were aware of different guidelines to manage BTcP. Notably, attitudes toward guidelines were highly positive and there was nearly unanimous agreement that CPG provided the best scientific evidence available (99%), on the minimum information to be gathered for the medical history (100%), on the need for a specific treatment for BTcP (100%), and fentanyl as the first-choice drug (99%). Interestingly, there were discrepancies between what oncologists agreed with and what they do in clinical practice. In fact, 87.6% declare full compliance with SEOM guideline, although adherence to registration of BTcP data in medical records ranged from 30.1 to 91.6% (mean 64.5%); therapeutic management compliance was higher ranging from 75.9 to 91.6%. Main barriers identified were time pressure together with vague statements and limited dissemination of the guidelines. Conclusion. Despite oncologist’s clinical practice is increasingly guided by GPC, it suffers from limited compliance, at least in part due to suboptimal statements. Improved dissemination and education are needed to enhance guideline implementation

No disponible

Mortalidad hospitalaria de pacientes nonagenarios en Medicina Interna / Mortality hospital of nonagenarian patients in Internal Medicine

Objetivos. Describir los factores predictivos de mortalidad hospitalaria en pacientes nonagenarios. Pacientes y método. Se estudió retrospectivamente a 421 pacientes ≥ 90 años ingresados en un servicio de Medicina Interna. Se analizó mediante regresión logística la asociación de parámetros demográficos, clínicos y funcionales con la mortalidad intrahospitalaria. Resultados. La edad media (DE) fue de 92,5 años (2,5), con 265 (62,9%) mujeres. Los principales diagnósticos fueron enfermedades infecciosas (257 pacientes, 61%) e insuficiencia cardiaca (183, 43,5%), y la estancia media fue de 11,9 días (8,6). Durante el ingreso fallecieron 96 pacientes (22,8%). Los factores predictivos de mortalidad fueron la edad (p = 0,002), el estado funcional (p = 0,006), la comorbilidad (p = 0,018) y los diagnósticos de neumonía (p = 0,001), sepsis (p = 0,012) e insuficiencia respiratoria (p < 0,001). Conclusión. La mortalidad hospitalaria de pacientes nonagenarios atendidos en Medicina Interna supera el 20% y se asocia a neumonía, carga de comorbilidad y deterioro funcional (AU)

Objectives. To describe the predictors of hospital mortality in nonagenarian patients. Patients and method. We retrospectively studied 421 patients aged 90 years or older hospitalised in a department of internal medicine. Using logistic regression, we analysed the association between demographic, clinical and functional parameters and hospital mortality. Results. The mean age was 92.5 years (SD±2.5), and 265 (62.9%) of the patients were women. The main diagnoses were infectious diseases (257 patients, 61%) and heart failure (183, 43.5%), and the mean stay was 11.9 days (SD±8.6). During the hospitalisation, 96 patients died (22.8%). The predictors of mortality were age (P=.002), functional state (P=.006), comorbidity (P=.018) and diagnoses of pneumonia (P=.001), sepsis (P=.012) and respiratory failure (P<.001). Conclusion. The hospital mortality of nonagenarian patients treated in internal medicine exceeds 20% and is associated with pneumonia, comorbidity burden and functional impairment (AU)

SEOM clinical guidelines for the treatment of head and neck cancer (2017)

Head and neck cancer (HNC) is defined as malignant tumours located in the upper aerodigestive tract and represents 5% of oncologic cases in adults in Spain. More than 90% of these tumours have squamous histology. In an effort to incorporate evidence obtained since 2013 publication, Spanish Society of Medical Oncology (SEOM) presents an update of HNC diagnosis and treatment guideline. The eighth edition of TNM classification, published in January 2017, introduces important changes for p16-positive oropharyngeal tumours, for lip and oral cavity cancer and for N3 category. In addition, there are new data about induction chemotherapy and the role of immunotherapy in HNC (AU)

No disponible

A novel capillary nano-immunoassay for assessing androgen receptor splice variant 7 in plasma. Correlation with CD133 antigen expression in circulating tumor cells. A pilot study in prostate cancer patients

Purpose. Androgen receptor (AR) splice variant 7 (AR-V7) has been related with both a higher risk of prostate cancer (PC) progression and differential responsiveness to hormonal agents versus chemotherapy. The objective of this study was to investigate the feasibility of a novel capillary nano-immunoassay in assessing AR-V7 in plasma from PC patients. Methods. Patients with either localized or advanced PC were included in the study. Assessment of AR-V7 in plasma was performed through a capillary nano-immunoassay platform. Correlation with clinical data, stem cell biomarkers (such as CD133+), AR amplification and PTEN status was identified. Results. The study included 72 PC patients. AR-V7 signal was detected in 21 (29%) patients: 17 (81%) had a Gleason score ≥7, 15 (71%) castration-resistant prostate cancer (CRPC), 18 (86%) metastatic disease and PSA (median) high than AR-V7 negative (p < 0.05). CD133 was expressed in 69 (96%) patients. The median CD133+ expression in circulating tumor cells CTCs was higher among the 21 AR-V7 positive cases versus AR-V7 negative (7 vs. 3). Androgen Receptor and PTEN fluorescence in situ hybridization (FISH) on CD133+ captured cells were performed: 37 cases showed ≥four CD133+ CTCs, of which 81% showed an increased AR copy number. This percentage was similar in both AR-V7-positive and AR-V7-negative patients. A total of 68% of the cases showed deletion of PTEN: 70% were ARV-7 positive vs. 67%, which were AR-V7 negative. Conclusions. Assessing the presence of AR-V7 in plasma from PC patients is feasible by a novel capillary nano-immunoassay. AR-V7 was observed in 29% of the tumors and is more frequent in aggressive tumors (AU)

No disponible

Epidemiological characteristics of a Spanish cohort of patients diagnosed with squamous cell carcinoma of head and neck: distribution of risk factors by tumor location

Purpose. Head and neck cancer is a highly heterogeneous disease comprising a large number of tumors located in the cervicofacial area. This study aimed to determine the epidemiological characteristics of squamous-cell carcinomas of the head and neck in the Spanish population, and the distribution of risk factors based on tumor locations. Methods/patients. A cohort of 459 patients (75 oral cavity, 167 oro-/hypopharyngeal and 217 laryngeal cancers) recruited in 19 hospitals participating in the Spanish head and neck cancer cooperative group were included over 3 years (2012-2014). Epidemiological parameters and risk factors were obtained from a self-administered questionnaire, and tumor characteristics were obtained from clinical records. Multivariate multinomial logistic regression was used to assess factors associated with tumor location. Results. Most patients were males (88.4 %), smokers (95 %) and drinkers (76.5 %). Relative to laryngeal cancer, pharyngeal cancer and oral cancer were more common in women than men (OR 3.58, p = 0.003 and 4.33, p = 0.001, respectively); pharyngeal cancer was more associated with rural environment (OR 1.81, p = 0.007) and weekly alcohol intake (10-140 g: OR 2.53, p = 0.012; 141-280 g: OR 2.47, p = 0.023; >280 g: OR 3.20, p = 0.001) and less associated with pack-years of smoking (21-40 packs: OR 0.46, p = 0.045; 41-70 packs: OR 0.43, p = 0.023; ≥71 packs: OR 3.20, p = 0.015). Conclusions. The distribution of these tumors differs between the sexes, with a higher proportion of oral cavity and pharyngeal tumors in women than in men. Oro-/hypopharyngeal cancers were more strongly associated with rural areas and with alcohol consumption, although less strongly associated with smoking than laryngeal tumors (AU)

No disponible

Social value of a quality-adjusted life year (QALY) in Spain: the point of view of oncologists

PURPOSE: The economic situation showed that the resources devoted to health spending are limited, making rationalisation of their consumption necessary. The relevance of pharmacoeconomic analyses is becoming crucial. The ECO Foundation, promoting the quality of oncology care, set out to analyse the consensus on the new therapeutic targets inclusion and the integration of pharmacoeconomics when evaluating their effectiveness. METHODS: Study about pharmacoeconomic estimations was performed during the first ECO-Seminar (2010). It was developed using a modified Delphi method, in four stages: (1) committee coordinator establishment, (2) expert-panel selection, (3) preparation and submission of survey (1 question) by email, and (4) analysis of the degree of consensus reached. RESULTS: Results were obtained from surveys completed by 35 experts. Regarding the tolerable annual cost for the approval of new drugs, 68.8 % of the respondents considered a cost per quality-adjusted life year (QALY) gained between 30,000 and 100,000 acceptable (34.4 % 30,000-60,000; 34.4 % 60,000-100,000), 21.9 % of the respondents found costs between 100,000-150,000/QALY and 9.3 % of the respondents found costs above 150,000/QALY acceptable. CONCLUSIONS: The costs of new drugs are higher than traditional treatments, making it a priority to identify subgroups of patients with specific molecular profiles as candidates for higher-efficiency-targeted therapies. The allocation of the available resources to the most effective interventions, to achieve the best clinical outcomes with lower costs and best subjective profile possible, allows expenditure to be rationalised. Pharmacoeconomic studies are a basic tool for obtaining better health outcomes according to the available resources, while also considering the other needs of the population (AU)

No disponible

SEOM Guidelines 2013: a response to the needs of Spanish oncologists

No disponible

Treatment needs for Dental Caries, Restorative Care Index, and Index of Extractions in adolescents 12 and 15 years old / Necesidades de tratamiento para Caries Dental, Indice de Cuidados Restauradores, e Índice de Extracciones en adolescentes de 12 y 15 años de edad

OBJECTIVE: To determine the Treatment Needs Index (TNI) for dental caries, the restorative Care Index (CI), and to introduce a Tooth Extractions Index (TEI) to estimate past and current treatment needs among Mexican adolescents. SUBJECT AND METHODS: A descriptive cross-sectional study was carried out on 1538 adolescents aged 12 and 15 years in the state of Hidalgo, Mexico, to collect decayed, missing, filled teeth (DMFT) data to describe TNI, CI and TEI indices. RESULTS: Higher TNI was identified in younger male teenagers who had always lived in the same community, without dental visits in the last year, and who had poorer socio-economic markers. Higher CI was found in older, female subjects who had moved in their lifetimes to a new community in the area, with dental visits in the last year and who had better socio-economic markers. Higher TEI was found in older, female teenagers who had moved in their lifetimes to a new community in the area, without dental visits in the last year, and who had worse socio-economic markers. CONCLUSIONS: We observed high rates of treatment needs for dental caries and little experience of restorative treatment. While dental extractions due to advanced caries should ideally be zero, relatively few adolescents had this treatment experience. Despite the fact that the overall background of these adolescents is rather homogeneous, it was still possible to find that treatment needs'indices (past and present needs) appeared to be modified by sociodemographic and socio-economic variables.

OBJETIVO: Determinar las necesidades de tratamiento para caries dental (INT), el índice de cuidados restauradores (IC) así como proponer un índice que haga referencia a las extracciones dentales (IE), para estimar necesidades de tratamiento actual y pasada en adolescentes mexicanos. MATERIAL Y MÉTODOS: Se realizó un estudio transversal descriptivo en 1538 adolescentes de 12 y 15 años en el Estado de Hidalgo, México. Empleando el índice CPOD se calcularon los índices TNI e IC; asimismo se propone un IE a las que ha estado expuesta la población. RESULTADOS: El INT fue mayor en los de 12 años, hombres, los que vivieron siempre en la misma comunidad, que no tuvieron visita al dentista en el último año, y con marcado nivel socioeconómico bajo. El IC fue mayor en los sujetos de 15 años, las mujeres, con migración interna, que si tuvieron visita al dentista en el último año, y con mejor nivel socioeconómico. El IE fue mayor en los de 15 años, mujeres, con migración interna, que no tuvieron visita al dentista en el último año, y con peores condiciones socioeconómicas. CONCLUSIONES: Se observaron altas necesidades insatisfechas de tratamiento para caries dental y poca experiencia de tratamiento restaurador. Las extracciones se observaron en pocos adolescentes, considerando cero como ideal. A pesar de que los antecedentes de estos adolescentes es bastante homogéneo, fue posible encontrar que los índices de necesidades de tratamiento (necesidades presentes y pasadas) parecen ser modificados por variables socio-demográficas y socioeconómicas.

SEOM clinical guidelines: a consolidated project

No disponible

Documento de Consenso sobre el uso de factores estimuladores de colonias de granulocitos biosimilares para la corrección de la neutropenia asociada en pacientes con cáncer / No disponible

No disponible

Consumo de alcohol en pacientes en tratamiento sustitutivo con opiáceos medido con el cuestionario AUDIT y su relación con otros factores asociados / Consumption of alcohol, as measured by the AUDIT questionnaire, in patients in methadone maintenance treatment programs and its relation with other associate factors

Objetivo. Estudiar la posible relación entre consumo de alcohol, medido a través del autoinforme AUDIT, con las de opiáceos (TSO), así como su relación con otros factores presentes frecuentemente en esta población. Material y método. Se tomó una muestra aleatoria de 80 pacientes del Centro de Tratamiento de Drogodependencias de Moratalaz, a quienes se les administró el cuestionario AUDIT. Se obtuvieron datos relacionados con la patología de base y el consumo de diferentes sustancias de la historia clínica. Resultados. Se dividió a los pacientes en grupos, dependiendo de si habían obtenido una puntuación superior o inferior a las puntuaciones de corte propuestas por los autores del test. No hubo diferencias estadísticamente significativas entre las medias de metadona diarias, el consumo de cocaína, la infección por el virus de la inmunodeficiencia humana y por el virus de la hepatitis C entre dichos grupos. Encontramos una mayor prevalencia de consumo de riesgo de alcohol entre aquellos pacientes con diagnóstico de patología dual o que consumían benzodiacepinas, con diferencias estadísticamente significativas entre los diferentes grupos. Conclusiones. La dosis de metadona no tiene relación con el consumo de alcohol en nuestra muestra, aunque existe una alta prevalencia de consumo problemático de alcohol en los pacientes en TSO. El consumo de riesgo de alcohol se da con más frecuencia en usuarios de benzodiacepinas y en personas con patología dual (AU)

Objective. To study the relationship of alcohol consumption, measured with AUDIT test, with methadone dose in patients assigned to Methadone Maintenance Treatment (MMT) Programs, and other factors often present in this population. Material and methods. We took a random sample of 80 patients in the Drug Adiction Treatment Center of Moratalaz, who were given the AUDIT questionnaire. We obtained data related to the pathology and consumption of various substances from medical records. Results. Patients were divided into groups according to whether they had achieved a score higher or lower than the cut scores of proposed by the authors of the test. There was no significant statistically difference between the daily methadone dose, cocaine use, HIV and HCV among these groups. There was a higher prevalence of risk consumption of alcohol among those patients with a dual diagnosis or who consumed benzodiazepines, with statistically significant differences between different groups. Conclusions. The methadone dose is not associated with the consumption of alcohol in our sample, although there is a high prevalence of alcohol consumption problematic for patients in MMTP. Risky alcohol consumption is more frequent within benzodiazepine users and dual diagnosis (AU)

Spanish Society of Medical Oncology consensus on the use of erythropoietic stimulating agents in anaemic cancer patients

Treatment of anaemia is a very important aspect in the management of cancer patients. In order to carry out a consensus process about the use of erythropoietic stimulating agents (ESAs) in cancer patients, the Spanish Society of Medical Oncology (SEOM) elaborated a working group which coordinated a panel of medical oncology specialists. This working group has reviewed the main issues about the use of ESAs. In addition a consensus meeting was held in Madrid on 25 April 2007. The following conclusions were made: Since ESA treatment increases the haemoglobin (Hb) level and decreases the red blood cell (RBC) transfusion requirements, ESAs should be used within the approved indications in patients undergoing chemotherapy treatment, beginning at a Hb level below 11 g/dl and maintaining it around 12 g/dl, with iron supplements if necessary. Neither increasing the ESA dose in nonresponders nor the use of ESAs in the treatment of chronic cancer-related anaemia is recommended (AU)

No disponible

Supervivencia en una cohorte con EPOC. Análisis comparativo entre el primer y tercer niveles de atención / Survival in a cohort of patients with chronic obstructive pulmonary disease: comparison between primary and tertiary levels of care

Objetivo: Comparar la probabilidad de supervivencia acumulada en una cohorte de pacientes con enfermedad pulmonar obstructiva crónica (EPOC) atendidos en primer y tercer niveles. Pacientes y método: En el Departamento de Neumología del Centro Médico Nacional La Raza (México DF) se efectuó un estudio de cohortes en 87 enfermos de 114 con diagnóstico confirmado de EPOC. Todos entraron en un programa de actividad física y educacional de 6 meses; se les efectuaron pruebas diagnósticas recomendadas por la American Thoracic Society para la EPOC y se formaron 2 grupos: grupo A, formado por 44 pacientes atendidos en el tercer nivel, y grupo B, compuesto por 43 pacientes atendidos en el primer nivel. El seguimiento se llevó de 1993 a 2001. En todos se contabilizaron las exacerbaciones, los ingresos hospitalarios, el tiempo de ejercicio, la estancia hospitalaria y las defunciones o abandono del estudio. Anualmente se realizaron pruebas de la función respiratoria. Se analizaron la mortalidad anual y total, la distribución por sexos, los años potenciales de vida perdidos, la edad media de fallecimiento y la probabilidad acumulada de supervivencia. Resultados: No hubo diferencia entre las características poblacionales ni iniciales. Ambos grupos mostraron un declive de la función respiratoria, aunque fue menor en el grupo A (volumen espiratorio forzado en el primer segundo del 8,93 ± 8,72 frente al 17,71 ± 2,51%; caída anual de la presión arterial de oxígeno de 1,39 frente a 1,95 mmHg). Las exacerbaciones anuales fueron 0,23 frente a 2,07; las hospitalizaciones, 0,06 frente a 0,92, y los días de estancia, 15,76 frente a 17,32. La edad media de fallecimiento fue de 66,12 frente a 60,6; los años de vida perdidos de 13,88 frente a 19,4, y la probabilidad acumulada de supervivencia de 0 frente a 0,224. Conclusiones: Las razones de las diferencias encontradas son múltiples: mejor control médico, educación para la salud y corresponsabilidad familiar. Estos factores, incluidos en las guías internacionales de la EPOC, deben difundirse al primer nivel de atención

Objective: To compare the cumulative probability of survival in a cohort of patients with chronic obstructive pulmonary disease (COPD) attended at primary and tertiary levels of health care. Patients and method: A cohort study was carried out at the Department of Pneumology of the Centro Médico Nacional La Raza (Mexico DF) on 87 of the 114 patients with confirmed diagnosis of COPD. All patients followed a 6-month physical activity and educational program. Patients underwent the COPD diagnostic tests recommended by the American Thoracic Society and were randomized and distributed in 2 groups: Group A had 44 patients who received tertiary care, and Group B had 43 who received primary care. Follow up lasted from 1993 to 2001. Exacerbations, hospital admissions, exercise duration, hospital stay, and death or study abandonment were recorded for all patients. Respiratory function tests were performed annually. Annual and total mortality, distribution by sex, loss in life expectancy, mean age at death, and cumulative probability of survival were analyzed. Results: No differences were found between the groups in population or initial characteristics. Respiratory function declined in both groups, although the decline was smaller in Group A: mean (SD) forced expired volume in 1 second, 8.93% (8.72%) compared with 17.71% (2.51%) and annual drop in blood pressure of 1.39 mm Hg compared with 1.95 mm Hg. Annual exacerbations were 0.23 in Group A compared with 2.07 in Group B; hospitalizations, 0.06 compared with 0.92, and length of stay, 15.76 days compared with 17.32 days. Mean age at death was 66.12 compared with 60.6; loss of life expectancy was 13.88 years lost compared with 19.4, and the cumulative probability of survival was 0 compared with 0.224. Conclusions: There are many reasons for the differences found: better medical management, health education, and family involvement at the tertiary level. These factors, included in international COPD guidelines, must be incorporated into primary health care