[Improving the nutritional care of oncology patients - Validation of a multidisciplinary protocol in the Spanish clinical setting]. / Mejorando la atención nutricional del paciente oncológico: validación de un protocolo multidisciplinar en el entorno clínico español.

INTRODUCTION: malnutrition is a very frequent problem in oncology patients and can have serious repercussions. Adequate nutritional management is cost-effective in terms of health and survival in this population, but it requires multidisciplinary coordination, specific training, and continuous follow-up. OBJECTIVE: to validate the applicability and efficacy of a multidisciplinary nutritional support protocol in oncology patients. METHODS: a multidisciplinary nutritional protocol was developed for oncology patients, with guidelines for screening and assessment of malnutrition, treatment, re-evaluation, and management of side effects, as well as guidance on supplementation and eating patterns. The protocol would be implemented in various clinical centers, collecting data through a structured questionnaire, registering variables before and after implementation. RESULTS: the protocol and its impact were implemented and evaluated in 39 centers. An improvement in nutritional care was observed, evidenced by an earlier initiation of nutritional assessment and an increase in the number of patients receiving adequate care following the protocol implementation. Problems related to inadequate malnutrition coding in the centers, limited resources, and the need for greater interdepartmental collaboration were identified. CONCLUSIONS: the conduct of this study provides insights into how the implementation of a multidisciplinary nutritional support protocol can improve the nutritional care received by patients and informs about the main obstacles to adequate implementation.

Control metabólico y de factores de riesgo cardiovascular en una cohorte de pacientes con diabetes mellitus. Resultados a los 4 años / Metabolic and cardiovascular risk factor control in a diabetic cohort. Four-year results

Objetivos Valorar el grado de control glucémico y del resto de factores de riesgo cardiovascular en una cohorte de pacientes diabéticos seguidos en consultas externas durante 4 años. Conocer el patrón de tratamiento utilizado y su evolución. Material y métodos Estudio de 424 pacientes diabéticos tanto tipo 1 (DM1) como tipo 2 (DM2), seleccionados aleatoriamente en 2004 y seguidos hasta 2008. La cohorte final fue de 343 pacientes. Se recogieron datos epidemiológicos, factores de riesgo cardiovascular, complicaciones crónicas, datos de control glucémico, lipídico y tensional, así como de tratamiento al inicio y a los 4 años. Resultados Tras los 4 años, el porcentaje de pacientes que conseguían una hemoglobina glicada inferior a 7% se mantuvo estable (DM1 18,5 en 2004 frente a 21,7% en 2008 y DM2 26,6 frente a 26,5%). En ambos tipos de diabetes se incrementó de forma significativa el grado de consecución de objetivos de control lipídico y tensional. Para conseguir estos resultados las pautas de tratamiento se complicaron de manera significativa. Conclusiones La estabilización del control glucémico objetivada tras 4 años de seguimiento es un resultado positivo, considerando el largo tiempo de evolución de la enfermedad, el deterioro progresivo de la función pancreática y la complejidad de esta cohorte. Gracias a la optimización de los tratamientos utilizados, han mejorado de forma significativa el control tensional y lipídico del grupo estudiado(AU)

Objectives To assess control of blood glucose and other cardiovascular risk factors in diabetic patients monitored at an outpatient endocrinology clinic. To ascertain treatment used and its changes over time. Patients and methods A cohort of 424 randomly selected diabetic patients (both type 1 and type 2) was monitored from 2004 to 2008. Final cohort size was 343 patients. Data were collected about epidemiological characteristics, cardiovascular risk factors, chronic complications, glycemic, lipid and blood pressure control, and treatment at baseline and 4 years. Results After 4 years, the proportion of patients achieving glycosylated hemoglobin levels less than 7% remained stable (type 1: 18.5% in 2004 vs 21.7% in 2008, type 2: 26.6% vs 26.5%). The degree of achievement of lipid and blood pressure (BP) control levels increased in both groups. The complexity of treatment schemes used to achieve these results significantly increased. Conclusions Stabilization of glycemic control after 4 years of follow-up was a positive result, considering the long course of diabetes, progressive pancreatic function impairment, and complexity of our cohort. Treatment optimization significantly improved BP and lipid control in the study group(AU)

Metabolic and cardiovascular risk factor control in a diabetic cohort. Four-year results.

OBJECTIVES: To assess control of blood glucose and other cardiovascular risk factors in diabetic patients monitored at an outpatient endocrinology clinic. To ascertain treatment used and its changes over time. PATIENTS AND METHODS: A cohort of 424 randomly selected diabetic patients (both type 1 and type 2) was monitored from 2004 to 2008. Final cohort size was 343 patients. Data were collected about epidemiological characteristics, cardiovascular risk factors, chronic complications, glycemic, lipid and blood pressure control, and treatment at baseline and 4 years. RESULTS: After 4 years, the proportion of patients achieving glycosylated hemoglobin levels less than 7% remained stable (type 1: 18.5% in 2004 vs 21.7% in 2008, type 2: 26.6% vs 26.5%). The degree of achievement of lipid and blood pressure (BP) control levels increased in both groups. The complexity of treatment schemes used to achieve these results significantly increased. CONCLUSIONS: Stabilization of glycemic control after 4 years of follow-up was a positive result, considering the long course of diabetes, progressive pancreatic function impairment, and complexity of our cohort. Treatment optimization significantly improved BP and lipid control in the study group.

Carcinoma diferenciado de tiroides: supervivencia y factores relacionados / Differentiated thyroid carcinoma: survival and prognostic factors

Antecedentes y objetivo El cáncer diferenciado de tiroides (CDT) es el tumor endocrino más frecuente, con buen pronóstico y supervivencias superiores al 85%. El objetivo de nuestro trabajo es conocer la supervivencia actual de nuestra serie de CDT y analizar los factores relacionados. Pacientes y métodos Realizamos un estudio retrospectivo de una cohorte de pacientes con CDT (n: 308), 93,5% eran papilares, el 78,2% eran mujeres con una edad media al diagnóstico de 45,4±15,8 años y un tiempo de seguimiento de 8,9 ± 6,8 años. Han sido tratados y seguidos de forma homogénea en nuestro centro hospitalario. Para cada paciente se ha recogido edad al diagnóstico, sexo, histología, estadio TNM, tratamientos empleados y fecha y causa de la muerte. La probabilidad de supervivencia fue calculada por el método de Kaplan Meier. Para analizar los factores relacionados con la supervivencia se realizó un análisis univariante (Log Rank test) y multivariante (Riesgos proporcionales de Cox).Resultados Se produjeron 26 casos de muerte, de ellos 15 pacientes (4,9%) murieron como consecuencia del CDT. La probabilidad de supervivencia acumulada del grupo total fue del 92,7%. En el análisis multivariante las variables asociadas de forma independiente con mortalidad por CDT fueron: metástasis a distancia, tipo histológico folicular, edad al diagnóstico más de 60 años y afectación extratiroidea. Discusión La probabilidad de supervivencia de nuestra serie es equiparable a la de la literatura. El conocimiento de los factores relacionados con peor supervivencia en el medio que trabajamos, es importante para establecer estrategias más activas de tratamiento en pacientes de alto riesgo (AU)

Background and aims Differentiated thyroid carcinoma (DTC) is the most common endocrine tumor. DTC has a good prognosis and survival rates higher than 85%. The aim of our study was to assess our current survival rate and to analyze prognostic factors. Patients and methods A retrospective analysis was conducted of 308 patients with DTC (93.5% with papillary tumors, 78.8% women). Mean age at diagnosis was 45.4±15.8years, and mean follow-up time was 8.9±6.8 years. The whole group was treated and followed up using the same protocol at our hospital. The following data were collected: age at diagnosis, sex, histology, TNM stage, treatments, and date and cause of death. Survival probability was calculated using Kaplan-Meier analyses. Prognostic factors were analyzed using a univariate log rank test and a multivariate Cox regression analysis model. Results Twenty-six patients died during follow-up, 15 of them (4.9%) from DTC. Thyroid carcinoma-related survival was 92.7% for the whole group. In multivariate analyses, the following parameters were associated to a significantly increased risk of death from DTC: presence of distant metastases, follicular histology, age at diagnosis older than 60 years, and extrathyroid invasion. Discussion Our survival rate is similar to that reported in literature. Assessment of prognostic factors related to an increased risk of death in our patient group, is essential to establish active therapeutic approaches in high risk patients (AU)

[Differentiated thyroid carcinoma: survival and prognostic factors]. / Carcinoma diferenciado de tiroides: supervivencia y factores relacionados.

BACKGROUND AND AIMS: Differentiated thyroid carcinoma (DTC) is the most common endocrine tumor. DTC has a good prognosis and survival rates higher than 85%. The aim of our study was to assess our current survival rate and to analyze prognostic factors. PATIENTS AND METHODS: A retrospective analysis was conducted of 308 patients with DTC (93.5% with papillary tumors, 78.8% women). Mean age at diagnosis was 45.4±15.8years, and mean follow-up time was 8.9±6.8years. The whole group was treated and followed up using the same protocol at our hospital. The following data were collected: age at diagnosis, sex, histology, TNM stage, treatments, and date and cause of death. Survival probability was calculated using Kaplan-Meier analyses. Prognostic factors were analyzed using a univariate log rank test and a multivariate Cox regression analysis model. RESULTS: Twenty-six patients died during follow-up, 15 of them (4.9%) from DTC. Thyroid carcinoma-related survival was 92.7% for the whole group. In multivariate analyses, the following parameters were associated to a significantly increased risk of death from DTC: presence of distant metastases, follicular histology, age at diagnosis older than 60years, and extrathyroid invasion. DISCUSSION: Our survival rate is similar to that reported in literature. Assessment of prognostic factors related to an increased risk of death in our patient group, is essential to establish active therapeutic approaches in high risk patients.