Quality indicators and excellence requirements for a multidisciplinary lung cancer tumor board by the Spanish Lung Cancer Group

Multidisciplinary care is needed to decide the best therapeutic approach and to provide optimal care to patients with lung cancer (LC). Multidisciplinary teams (MDTs) are optimal strategies for the management of patients with LC and have been associated with better outcomes, such as an increase in quality of life and survival. The Spanish Lung Cancer Group has promoted this review about the current situation of the existing national LC-MDTs, which also offers a set of excellence requirements and quality indicators to achieve the best care in any patient with LC. Time and sufficient resources; leadership; administrative and institutional support; and recording of activity are key factors for the success of LC-MDTs. A set of excellence requirements in terms of staff, resources and organization of the LC-MDT have been proposed. At last, a list of quality indicators has been agreed to achieve and measure the performance of current LC-MDTs.

Quality indicators and excellence requirements for a multidisciplinary lung cancer tumor board by the Spanish Lung Cancer Group.

Multidisciplinary care is needed to decide the best therapeutic approach and to provide optimal care to patients with lung cancer (LC). Multidisciplinary teams (MDTs) are optimal strategies for the management of patients with LC and have been associated with better outcomes, such as an increase in quality of life and survival. The Spanish Lung Cancer Group has promoted this review about the current situation of the existing national LC-MDTs, which also offers a set of excellence requirements and quality indicators to achieve the best care in any patient with LC. Time and sufficient resources; leadership; administrative and institutional support; and recording of activity are key factors for the success of LC-MDTs. A set of excellence requirements in terms of staff, resources and organization of the LC-MDT have been proposed. At last, a list of quality indicators has been agreed to achieve and measure the performance of current LC-MDTs.

KRAS p.G12C mutation occurs in 1% of EGFR-mutated advanced non-small-cell lung cancer patients progressing on a first-line treatment with a tyrosine kinase inhibitor.

BACKGROUND: KRAS is mutated in ∼30% of non-small-cell lung cancer (NSCLC) but it has also been identified as one of the mechanisms underlying resistance to tyrosine kinase inhibitors (TKIs) in EGFR-positive NSCLC patients. Novel KRAS inhibitors targeting KRAS p.G12C mutation have been developed recently with promising results. The proportion of EGFR-positive NSCLC tumours harbouring the KRAS p.G12C mutation upon disease progression is completely unexplored. MATERIALS AND METHODS: Plasma samples from 512 EGFR-positive advanced NSCLC patients progressing on a first first-line treatment with a TKI were collected. The presence of KRAS p.G12C mutation was assessed by digital PCR. RESULTS: Overall, KRAS p.G12C mutation was detected in 1.17% of the samples (n = 6). In two of these cases, we could confirm that the KRAS p.G12C mutation was not present in the pre-treatment plasma samples, supporting its role as an acquired resistance mutation. According to our data, KRASG12C patients showed similar clinicopathological characteristics to those of the rest of the study cohort and no statistically significant associations between any clinical features and the presence of the mutation were found. However, two out of six KRASG12C tumours harboured less common EGFR driver mutations (p.G719X/p.L861Q). All KRASG12C patients tested negative for the presence of p.T790M resistance mutation. CONCLUSIONS: The KRAS p.G12C mutation is detected in 1% of EGFR-positive NSCLC patients who progress on a first line with a TKI. All KRASG12C patients were negative for the presence of the p.T790M mutation and they did not show any distinctive clinical feature.

Enfermedad de von Recklinghausen asociada a cáncer de colon: amistades peligrosas / Von Recklinghausen disease associated with colon cancer: dangerous friendships

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Ventilación mecánica no invasiva en ancianos con insuficiencia cardíaca aguda / Non invasive ventilation in elderly with acute heart failure

OBJETIVO: comprobar la utilidad de la ventilación mecánica no invasiva (VMNI) en ancianos que ingresan en una Unidad de Monitorización Respiratoria (UMR) en situación de acidosis respiratoria secundaria a insuficiencia cardíaca. MÉTODOS: estudio prospectivo observacional, realizado en el Hospital Universitario La Princesa (Madrid), durante el periodo comprendido entre octubre del 2009 y diciembre del 2012. Se incluyeron a 42 pacientes ancianos (≥ 70 años) con diagnóstico de ingreso de insuficiencia cardíaca y acidosis respiratoria (pH < 7,35 y PaCO2 > 45 mm Hg). RESULTADOS: el 62% fueron mujeres. La edad media fue de 78,2 años. El índice de Charlson fue de 3,41 y la media de fármacos/día 5,8. El pH al ingreso fue de 7,24 (7,19 en el grupo que fallecieron) y una PaCO2 de 83,1 mm Hg (88,7 mm Hg en el grupo exitus). Las principales complicaciones durante el ingreso fueron cardiovasculares. La tasa de exitus fue del 25%. La principal causa de reingreso fue la insuficiencia cardíaca y la supervivencia global fue del 60%.CONCLUSIÓN: la VMNI es útil en el tratamiento de pacientes ancianos con insuficiencia cardíaca. Los principales factores asociados a mortalidad fueron: bajo pH y alta PaCO2 al ingreso, frecuencia respiratoria alta y mala situación basal

OBJECTIVE: the aim of the study was to determine the usefulness of non-invasive ventilation (NIV) in elderly with multiple comorbidities that were taken to hospital with respiratory acidosis due to heart failure and survivor after one year follow-up. METHOD: observational prospective trial made at the Hospital Universitario La Princesa (Madrid) between 2009 th october and 2012 th december. We included 42 elderly patients with heart failure and respiratory acidosis that needed NIV. RESULTS: 62% was women. The median age was 78,2 years. Charlson Index was 3,41 and the median of drugs that patients taken was about 5,8. The main complication during income was cardiovascular disease. 25% died during admission. The principal diagnosed of re-admission was heart failure. Global survivor was 60%. CONCLUSIONS: NIV is a good treatment for elderly patients with heart failure and non-intubation orders. The principal factors associated with mortality were: low pH and high PaCO2 at emergency department, high respiratory frequency and bad basal situation

Synchronous versus metachronous brain metastasis from testicular germ cell tumors (TGCT): an analysis from the Spanish Germ Cell Cancer Group data base

BACKGROUND: Brain metastases of testicular germ cell tumor (TGCT) are a rare event. Prognostic is poor and there is not much evidence on optimal management of these patients. PATIENTS AND METHODS: A review of case records of germ cell tumor patients within the Spanish Germ Cell Cancer Group data base from 1994 to 2012 was conducted. RESULTS: Thirty-three out of 6,200 cases (0.5 %). Nineteen patients (57 %) group 1: synchronous, 13 (40 %) group 2: metachronous and only one developed brain metastasis during cisplatin-based chemotherapy (excluded from the analysis). Median serum BHCG levels at initial diagnosis was higher in group 1, whereas elevated AFP serum levels were more common in group 2. Histology in the primary tumor: chorionic carcinoma for group 1 versus embryonal carcinoma for group 2. Mainly solitary brain metastasis in group 2 (54 versus 21 %, respectively). The median overall survival from the diagnosis of central nervous system involvement was 16 months for group 1 (CI 95 % 13.9-18) and 23 months (95 % CI 0-165) for group 2 (log rank p = 0.84). Long-term survivors were practically identical in the two groups (38.9 % group 1 versus 38.5 % group 2). Regardless of the timing of brain metastasis, those patients that achieved complete response to the treatment had better survival (log rank p 0.003). CONCLUSION: Although some distinctive clinical characteristics have been found between patients with synchronous versus metachronous brain metastasis from TGCT, the timing of brain metastasis did not seem to have prognostic influence, but due to the retrospective nature of the analysis and the results should be interpreted with caution (AU)

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Synchronous versus metachronous brain metastasis from testicular germ cell tumors (TGCT): an analysis from the Spanish Germ Cell Cancer Group data base.

BACKGROUND: Brain metastases of testicular germ cell tumor (TGCT) are a rare event. Prognostic is poor and there is not much evidence on optimal management of these patients. PATIENTS AND METHODS: A review of case records of germ cell tumor patients within the Spanish Germ Cell Cancer Group data base from 1994 to 2012 was conducted. RESULTS: Thirty-three out of 6,200 cases (0.5 %). Nineteen patients (57 %) group 1: synchronous, 13 (40 %) group 2: metachronous and only one developed brain metastasis during cisplatin-based chemotherapy (excluded from the analysis). Median serum BHCG levels at initial diagnosis was higher in group 1, whereas elevated AFP serum levels were more common in group 2. Histology in the primary tumor: chorionic carcinoma for group 1 versus embryonal carcinoma for group 2. Mainly solitary brain metastasis in group 2 (54 versus 21 %, respectively). The median overall survival from the diagnosis of central nervous system involvement was 16 months for group 1 (CI 95 % 13.9-18) and 23 months (95 % CI 0-165) for group 2 (log rank p = 0.84). Long-term survivors were practically identical in the two groups (38.9 % group 1 versus 38.5 % group 2). Regardless of the timing of brain metastasis, those patients that achieved complete response to the treatment had better survival (log rank p 0.003). CONCLUSION: Although some distinctive clinical characteristics have been found between patients with synchronous versus metachronous brain metastasis from TGCT, the timing of brain metastasis did not seem to have prognostic influence, but due to the retrospective nature of the analysis and the results should be interpreted with caution.

[Quantitative test to distinguish spinal fluid from saline solution in combined spinal-epidural anesthesia]. / Método cuantitativo para distinguir el líquido cefalorraquídeo de la solución salina en la anestesia combinada intradural-epidural.

OBJECTIVES: To validate the use of a digital blood glucose meter for detecting the presence of spinal fluid during combined spinal-epidural anesthesia in terms of specificity, positive and negative predictive values, and likelihood ratios. PATIENTS AND METHODS: Validation was studied in 30 patients scheduled for surgery under combined spinal-epidural anesthesia. A positive finding, defined as detection of spinal fluid return or aspiration by the epidural or spinal needle, was compared with results of standard reference tests (the pattern of sensory or motor block after administration of the local anesthetic). After locating the epidural space with saline solution, the test was performed and 3 mL of local anesthetic was administered. If no sensory or motor blockade was evident, the test was considered a true negative. Spinal puncture was then performed, the test was repeated, and 2 to 3 mL of local anesthetic was injected. The test was considered a true positive if sensory or motor blockade was evident. These findings entered into the validation analyses. RESULTS: Sensitivity was 100%, specificity 94%, positive predictive value 93%, negative predictive value 100%, the positive likelihood ratio 15.5, and negative likelihood 0. CONCLUSION: Blood glucose meter readings provide a valid quantitative measure for distinguishing spinal fluid from saline solution during combined spinal-epidural anesthesia. The method, which uses a readily available device, is easy to use to rule out the presence of spinal fluid.

Método cuantitativo para distinguir el líquido cefalorraquídeo de la solución salina en la anestesia combinada intradural-epidural / Quantitative test to distinguish spinal fluid from saline solution in combined spinalepidural anesthesia

OBJETIVOS: Proponer la utilización de un glucómetrodigital como método cuantitativo sencillo para detectarlíquido cefalorraquídeo durante la técnica de anestesiacombinada epidural-intradural y determinar su validez,a través de la sensibilidad, especificidad, valores predictivosy cocientes de probabilidad.PACIENTES Y MÉTODOS: Se realizó el estudio de validezdel test en 30 pacientes programados para cirugía conanestesia combinada intradural-epidural. Se consideróun resultado positivo si había glucosa en el líquido querefluía o se aspiraba a través de la aguja epidural eintradural, y se contrastaba con un patrón de referencia(las características del bloqueo sensitivo o motor tras laadministración de anestésico local). Tras localizar elespacio epidural con solución salina, se realizaba el testy se administraban 3 mL de anestésico local. Si no habíabloqueo sensitivo o motor, el test se consideraba verdaderonegativo. Se realizaba la punción dural, se realizabael test y se administraban 2-3 mL de anestésico local.En este caso si había bloqueo sensitivo o motor el test seconsideraba verdadero positivo. Con todo ello se realizóel análisis de validez.RESULTADOS: La sensibilidad del test fue del 100%, suespecificidad del 94%, el valor predictivo positivo de93%, y el valor predictivo negativo de 100%, la razón deprobabilidad positiva de 15,5 y la negativa de 0.CONCLUSIÓN: El glucómetro utilizado es un métodocuantitativo válido para diferenciar líquido cefalorraquídeode solución salina durante la anestesia combinada,de uso sencillo y fácilmente disponible, con una granutilidad para confirmar o descartar la presencia delíquido cefalorraquídeo(AU)

OBJECTIVES: To validate the use of a digital bloodglucose meter for detecting the presence of spinal fluidduring combined spinal-epidural anesthesia in terms ofspecificity, positive and negative predictive values, andlikelihood ratios.PATIENTS AND METHODS: Validation was studied in 30patients scheduled for surgery under combined spinalepiduralanesthesia. A positive finding, defined asdetection of spinal fluid return or aspiration by theepidural or spinal needle, was compared with results ofstandard reference tests (the pattern of sensory or motorblock after administration of the local anesthetic). Afterlocating the epidural space with saline solution, the testwas performed and 3 mL of local anesthetic wasadministered. If no sensory or motor blockade wasevident, the test was considered a true negative. Spinalpuncture was then performed, the test was repeated, and2 to 3 mL of local anesthetic was injected. The test wasconsidered a true positive if sensory or motor blockadewas evident. These findings entered into the validationanalyses.RESULTS: Sensitivity was 100%, specificity 94%,positive predictive value 93%, negative predictive value100%, the positive likelihood ratio 15.5, and negativelikelihood 0.CONCLUSION: Blood glucose meter readings provide avalid quantitative measure for distinguishing spinal fluidfrom saline solution during combined spinal-epiduralanesthesia. The method, which uses a readily availabledevice, is easy to use to rule out the presence of spinalfluid(AU)

Measurement of the D(s)+ lifetime.

A high statistics measurement of the D(s)+ lifetime from the Fermilab fixed-target FOCUS photoproduction experiment is presented. We describe the analysis of the two decay modes, D(s)+ --> phi(1020)pi+ and D(s)+ -->K*(892)0K+, used for the measurement. The measured lifetime is 507.4 +/- 5.5(stat) +/- 5.1(syst) fs using 8961 +/- 105 D(s)+ --> phi(1020)pi+ and 4680 +/- 90 D(s)+ --> K*(892)0K+ decays. This is a significant improvement over the present world average.

Enfermedad inflamatoria intestinal y sus complicaciones en atención primaria / Inflammatory intestinal disease and its complications in primary care

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A high statistics measurement of the Lambda(+)(c) lifetime.

A high statistics measurement of the Lambda(+)(c) lifetime from the Fermilab fixed-target FOCUS photoproduction experiment is presented. We describe the analysis technique with particular attention to the determination of the systematic uncertainty. The measured value of 204.6 +/- 3.4 (stat) +/- 2.5 (syst) fs from 8034 +/- 122 Lambda(+)(c)-->pK(-)pi(+) decays represents a significant improvement over the present world average.

Search for CP violation in the decays D+--> K(S)pi+ and D+-->K(S)K+.

A high-statistics sample of photoproduced charm from the FOCUS experiment has been used to search for direct CP violation in the decay rates for D+-->K(S)pi+ and D+-->K(S)K+. We have measured the following asymmetry parameters relative to D+-->K-pi+pi+: A(CP)(K(S)pi+) = (-1.6+/-1.5+/-0.9)%, A(CP)(K(S)K+) = (+6.9+/-6.0+/-1.5)%, and A(CP)(K(S)K+) = (+7.1+/-6.1+/-1.2)% relative to D+-->K(S)pi+. We have also measured the relative branching ratios and found Gamma(D+-->K(0)pi+)/Gamma(D+-->K-pi+pi+) = (30.60+/-0.46+/-0.32)%, Gamma(D+-->K(0)K+)/Gamma(D+-->K-pi+pi+) = (6.04+/-0.35+/-0.30)%, and Gamma(D+-->K(0)K+)/Gamma(D+-->K(0)pi+) = (19.96+/-1.19+/-0.96)%.

Measurement of the branching ratios of D(+) and D(+)(s) hadronic decays to four-body final states containing a K(S).

We have studied hadronic four-body decays of D(+) and D(+)(s) mesons with a K(S) in the final state using data recorded during the 1996-1997 fixed-target run of the Fermilab high energy photoproduction experiment FOCUS. We report a new branching ratio measurement of gamma(D(+)-->K(S)K-pi(+)pi(+))/gamma(D(+)-->K(S)pi(+)pi(+)pi(-)) = 0.0768+/-0.0041+/-0.0032. We make the first observation of three new decay modes with branching ratios gamma(D(+)-->K(S)K+pi(+)pi(-))/gamma(D(+)-->K(S)pi(+)pi(+)pi(-)) = 0.0562+/-0.0039+/-0.0040, gamma(D(+)-->K(S)K+K-pi(+))/gamma(D(+)-->K(S)pi(+)pi(+)pi(-)) = 0.0077+/-0.0015+/-0.0009, and gamma(D(+)(s)-->K(S)K+pi(+)pi(-))/gamma(D(+)(s)-->K(S)K-pi(+)pi(+)) = 0.586+/-0.052+/-0.043, where in each case the first error is statistical and the second error is systematic.

Study of the decay D0 --> K+pi-.

Using a large sample of photoproduced charm mesons from the FOCUS experiment at Fermilab (FNAL-E831), we observe the decay D0-->K+pi- with a signal yield of 149+/-31 events compared to a similarly cut sample consisting of 36 760+/-195 D0-->K-pi+ events. We use the observed ratio of D0-->K+pi- to D0-->K-pi+ (0.404+/-0.085+/-0.025)% to obtain a relationship between the D0 mixing and doubly Cabibbo suppressed decay parameters.

Compliance, satisfaction, and quality of life of patients with colorectal cancer receiving home chemotherapy or outpatient treatment: a randomised controlled trial.

OBJECTIVE: To compare chemotherapy given at home with outpatient treatment in terms of colorectal cancer patients' safety, compliance, use of health services, quality of life, and satisfaction with treatment. DESIGN: Randomised controlled trial. SETTING: Large teaching hospital. PARTICIPANTS: 87 patients receiving adjuvant or palliative chemotherapy for colorectal cancer. INTERVENTIONS: Treatment with fluorouracil (with or without folinic acid or levamisole) at outpatient clinic or at home. MAIN OUTCOME MEASURES: Treatment toxicity; patients' compliance with treatment, quality of life, satisfaction with care, and use of health resources. RESULTS: 42 patients were treated at outpatient clinic and 45 at home. The two groups were balanced in terms of age, sex, site of cancer, and disease stage. Treatment related toxicity was similar in the two groups (difference 7% (95% confidence interval -12% to 26%)), but there were more voluntary withdrawals from treatment in the outpatient group than in the home group (14% v 2%, difference 12% (1% to 24%)). There were no differences between groups in terms of quality of life scores during and after treatment. Levels of patient satisfaction were higher in the home treatment group, specifically with regard to information received and nursing care. There were no significant differences in use of health services. CONCLUSIONS: Home chemotherapy seemed an acceptable and safe alternative to hospital treatment for patients with colorectal cancer that may improve compliance and satisfaction with treatment.

[Chemoprevention in cancer of the head and neck]. / Quimioprevención en el cáncer de cabeza y cuello.

The world-wide incidence of cancer of the head and neck of 500,000 cases/year has remained unchanged in recent years in spite of anti-smoking campaigns. Moreover, long-term survivors of cancer of the head and neck or of other respiratory and digestive tumors have a constant annual 5-7% risk of developing a second primary tumor in the same area. Lately, prevention programs have added synthetic and natural products to prevention programs for the purpose of reversing the progression of premalignant lesions to invasive cancer or reducing the probability of developing cancer in high-risk individuals. These products are known as chemoprevention agents. In the case of tumors of the head and neck, it is known that leukoplasia and erythroplasia are epithelial lesions on which invasive tumors may develop. Recent studies have demonstrated that the use of retinoids can produce regression rates over 60%, thus reducing the risk of secondary neoplasms of the respiratory and digestive tract by 35-55%. The current status of chemoprevention in head and neck cancer and the use of retinoids as chemoprevention agents in this type of neoplasm are reviewed.

A historic-quantitative approach to psychophysiological research: the first three decades of the journal Psychophysiology (1964-1993).

We used quantitative methodology to examine the first three decades of the journal Psychophysiology from a stand-point of historic interest. A bibliometric analysis was conducted on 1,781 works published during this period. In total, 2,537 authors have published in the journal. The distribution of their productivity matches approximately what would be expected based on previous bibliometric investigations. A constant increase in the collaboration between researchers was evident (reaching an average of 2.56 authors per paper). The literature cited in these articles dates back between 4.53 and 8.12 years (M = 6.48 years). These bibliometric results show that this journal can be placed among the most experimentally oriented group within the field of psychology.