Fatal Events in Cancer Patients Receiving Anticoagulant Therapy for Venous Thromboembolism.

In cancer patients treated for venous thromboembolism (VTE), including deep-vein thrombosis (DVT) and pulmonary embolism (PE), analyzing mortality associated with recurrent VTE or major bleeding is needed to determine the optimal duration of anticoagulation.This was a cohort study using the Registro Informatizado de Enfermedad TromboEmbólica (RIETE) Registry database to compare rates of fatal recurrent PE and fatal bleeding in cancer patients receiving anticoagulation for VTE.As of January 2013, 44,794 patients were enrolled in RIETE, of whom 7911 (18%) had active cancer. During the course of anticoagulant therapy (mean, 181 ± 210 days), 178 cancer patients (4.3%) developed recurrent PE (5.5 per 100 patient-years; 95% CI: 4.8-6.4), 194 (4.7%) had recurrent DVT (6.2 per 100 patient-years; 95% confidence interval [CI]: 5.3-7.1), and 367 (8.9%) bled (11.3 per 100 patient-years; 95% CI: 10.2-12.5). Of 4125 patients initially presenting with PE, 43 (1.0%) died of recurrent PE and 45 (1.1%) of bleeding; of 3786 patients with DVT, 19 (0.5%) died of PE, and 55 (1.3%) of bleeding. During the first 3 months of anticoagulation, there were 59 (1.4%) fatal PE recurrences and 77 (1.9%) fatal bleeds. Beyond the third month, there were 3 fatal PE recurrences and 23 fatal bleeds.In RIETE cancer patients, the rate of fatal recurrent PE or fatal bleeding was much higher within the first 3 months of anticoagulation therapy

What format of treatment do patients with emotional disorders prefer and why? Implications for public mental health settings and policies

Objective We analyzed the preference of three psychological intervention formats—individual, group, and online—in a sample of 267 patients with a primary diagnosis of emotional disorder in Spanish public mental health settings. Method We studied patients’ preferences considering sociodemographic characteristics, diagnoses, history of psychological treatments, number of sessions, and satisfaction with past interventions. Results Most participants (85.4%) preferred psychological treatment in an individual format, 14.2% in group, and 0.4% online. When comparing the people who chose individual and group treatment, no demographic or clinical differences were found. The arguments against group format were the lack of privacy and expression difficulties. Regarding online format, these included being considered impersonal and ineffective. Conclusion The rejection of group and online psychotherapy formats allows us to define the actions we should carry out in public mental health settings to improve the acceptance of more costeffective therapy formats

Design and validation of the INCUE questionnaire: Assessment of primary healthcare Nurses’ basic training needs in palliative care

Many instruments have been created to measure knowledge and attitudes in palliative care. However, not only is it important to acquire knowledge, but also that this knowledge should reach patients and their relatives through application in clinical practice. This study aimed to develop and psychometrically test the INCUE questionnaire (Investigación Cuidados Enfermeros/Investigation into Nurses’ Care Understanding of End-of-Life) to assess the basic training needs of primary or home healthcare nurses in palliative care. A questionnaire was developed based on the classical theory of tests and factor analysis models. Initially, 18 experts developed 67 items in two blocks and determined content validity by two rounds of expert panels. Exploratory factor analysis and reliability testing were conducted with a non-probabilistic sample of 370 nurses. Some items were observed to have very low homogeneity indices or presented convergence problems and were eliminated. Questionnaire reliability was 0.700 in the theoretical block (KR20 Index) and 0.941 in the practical block (Cronbach’s alpha). The model converges and shows an adequate fit, specifically CFI = 0.977, TLI = 0.977 and RMSEA = 0.05. The correlation between the two factors in the model is ρ = 0.63. The questionnaire objectively evaluates primary or home healthcare nurses’ knowledge of palliative care and its practical application, thereby facilitating more efficient training plans.This questionnaire is being developed as part of a project to pinpoint the training needs of primary care nurses in the field of palliative care at the Dr Peset Health Department in Valencia (Project EAPCP19-V01)This project has received funding under the first Call for R + D Grants in Nursing 2019 (UGP-19-258), from the Fundació per al Foment de la Investigació Sanitària i Bioèdica de la Comunitat Valenciana (Fisabio).Enfermerí

Clinical Characteristics and Outcomes of Patients with Lung Cancer and Venous Thromboembolism

Background. The natural history of patients with lung cancer and venous thromboembolism (VTE) has not been consistently evaluated. Methods  We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to assess the clinical characteristics, time course, and outcomes during anticoagulation of lung cancer patients with acute, symptomatic VTE. Results  As of May 2017, a total of 1,725 patients were recruited: 1,208 (70%) presented with pulmonary embolism (PE) and 517 with deep vein thrombosis (DVT). Overall, 865 patients (50%) were diagnosed with cancer <3 months before, 1,270 (74%) had metastases, and 1,250 (72%) had no additional risk factors for VTE. During anticoagulation (median, 93 days), 166 patients had symptomatic VTE recurrences (recurrent DVT: 86, PE: 80), 63 had major bleeding (intracranial 11), and 870 died. The recurrence rate was twofold higher than the major bleeding rate during the first month, and over threefold higher beyond the first month. Fifty-seven patients died of PE and 15 died of bleeding. Most fatal PEs (84%) and most fatal bleeds (67%) occurred within the first month of therapy. Nine patients with fatal PE (16%) died within the first 24 hours. Of 72 patients dying of PE or bleeding, 15 (21%) had no metastases and 29 (40%) had the VTE shortly after surgery or immobility. Conclusion  Active surveillance on early signs and/or symptoms of VTE in patients with recently diagnosed lung cancer and prescription of prophylaxis in those undergoing surgery or during periods of immobilization might likely help prevent VTE better, detect it earlier, and treat it more efficiently.publishersversionPeer reviewe

Evaluación de una experiencia de flipped classroom

This paper has won a Runner-up Prize in the Financial Studies 2022 Award in the Education and New Technologies category. The flipped classroom is an active methodology that changes the traditional teaching model and generates an emotional connection with students (men and women). The purpose of this study is to analyse the extent to which the flipped classroom promotes meaningful learning and is related to students satisfaction and/or stress in a Quality Management course at the Universitat Jaume I, using the novel study demands-resources (SD-R) framework. The research concludes that the flipped classroom enables meaningful learning. Although perceptions of workload affect the level of stress of students, neither the workload nor the level of stress affect negatively in terms of learning.Este trabajo ha obtenido un Accésit del Premio Estudios Financieros 2022 en la modalidad de Educación y Nuevas Tecnologías. La flipped classroom es una metodología activa que cambia el modelo de enseñanza tradicional y genera una conexión emocional con el estudiantado (hombres y mujeres). El propósito de este estudio es analizar en qué medida la flipped classroom promueve el aprendizaje significativo del estudiantado y permite un aumento de su satisfacción y/o estrés en la docencia de la materia de Gestión de la Calidad en la Universitat Jaume I, utilizando el novedoso modelo de demandas y recursos en el estudio (DRE). La investigación concluye que la flipped classroom promueve el aprendizaje significativo. Si bien la percepción de carga de trabajo está relacionada con el nivel de estrés de los estudiantes, ni la carga de trabajo ni el nivel de estrés se traducen negativamente en términos de aprendizaje

Una visión de 360 grados sobre la actitud hacia la diversidad en el entorno universitario

Todos somos diferentes y esa diversidad enriquece la vida. El problema comienza cuando la diversidad desemboca en desigualdad. Una sociedad justa debe prestar atención hacia la diversidad desde todos los ámbitos, especialmente el educativo. La mayoría de las universidades de España cuenta con servicios de atención al alumnado con discapacidad. Estos desarrollan toda una serie de acciones de asesoramiento y apoyo a la comunidad universitaria, para eliminar las barreras y facilitar su integración y su participación. Además de realizar adaptaciones curriculares y facilitar recursos físicos, para que las personas con discapacidad se integren plenamente, es necesario prestar atención a las relaciones interpersonales que se establecen entre todos los miembros de la comunidad universitaria. El presente estudio trata de mostrar una visión de 360º sobre la actitud hacia la diversidad. Para ello se ha recogido la visión de estudiantes con discapacidad y también la de sus compañeros. Pero los alumnos son sólo una parte de la ecuación. Con el objetivo de obtener una visión más completa de la situación actual, también se ha entrevistado a los docentes. Dentro de este colectivo, se ha contado con la participación de profesores que han impartido docencia a estudiantes con discapacidad y también con la visión de los docentes con discapacidad

Cancer-Associated Thrombosis : Beyond Clinical Practice Guidelines-A Multidisciplinary (SEMI-SEOM-SETH) Expert Consensus

Altres ajuts: This work has been performed with an unrestricted grant from Aspen, Leo-Pharma, Laboratorios Farmacéuticos Rovi, and Sanofi.Despite the growing interest and improved knowledge about venous thromboembolism in cancer patients in the last years, there are still many unsolved issues. Due to the limitations of the available literature, evidence-based clinical practice guidelines are not able to give solid recommendations for challenging scenarios often present in the setting of cancer-associated thrombosis (CAT). A multidisciplinary expert panel from three scientific societies-Spanish Society of Internal Medicine (SEMI), Spanish Society of Medical Oncology (SEOM), and Spanish Society Thrombosis and Haemostasis (SETH)-agreed on 12 controversial questions regarding prevention and management of CAT, which were thoroughly reviewed to provide further guidance. The suggestions presented herein may facilitate clinical decisions in specific complex circumstances, until these can be made leaning on reliable scientific evidence

Enzyme replacement therapy for the treatment of Hunter disease: A systematic review with narrative synthesis and meta-analysis

Background: In the last 10 years enzyme replacement therapy (ERT) has become an alternative for the treatment of patients with Hunter disease (HD). Nevertheless, the information regarding efficacy and safety is scarce and mainly based on the pivotal trials. This scarcity is especially evident for adults and severe forms of HD. Methods: A systematic review of publications in the electronic databases PUBMED, EMBASE and Cochrane Central was undertaken. Clinical trials and observational studies were included. The data about efficacy and security were retrieved and analysed with Review Manager version 5.3. Results: 677 records were found, 559 remaining after the removal of duplicates. By title and abstract review, 427 were excluded. Full reading of the rest was made (122 publications) and 42 were finally included. It was not possible to perform meta-analysis of all the endpoints due to high heterogeneity in the reporting and measuring of variables in each publication. Eight clinical trials were included, 6 with high risk of bias. The quality of the other studies was low in 12%, average in 68% and good in 21%. Main findings were: a reduction in the elimination of glycosaminoglycans (GAG) in urine in all the studies (26/26), decrease in liver and spleen size (18/18), increase of 52.59 m (95% CI, 36, 42-68.76, p < .001) in the 6-min walk test (TM6M), increase in forced vital capacity (FVC) of 9.59% (95% CI 4.77-14.51, p < .001), reduction of the left ventricular mass index of 3.57% (95% CI 1.2-5.93) and reduction in mortality (OR) of 0.44 (0.27-0.71). Discussion: The data suggests a clear and consistent effect of ERT in HD reducing the accumulation of GAGs in the body, demonstrated by the reduction of its urinary excretion, as well as by the reduction of its deposits (spleen, liver and heart). Likewise, there is an improvement in physical and respiratory function. In addition, a reduction in mortality has been observed. Lack of studies, small size of the samples, and methodological deficiencies are the main limitations to establish definite conclusions. Conclusions: The data suggests that ERT is effective and safe in the treatment of HD. There is a need to evaluate patient-centred outcomes and the impact on quality of life

La adaptación de materiales docentes de marketing para estudiantes con necesidades especiales. Proyecto Speaking Library

Este trabajo presenta la experiencia docente de una Red multidisciplinar de investigadores (Red I+Do+i), en la que han participado profesorado y estudiantes. El objetivo principal de la experiencia docente “Speaking Library” es tiene una doble vertiente. Por un lado, generar documentos de trabajo especializados en investigación en docencia y en materias curriculares relevantes para el alumnado, así como en soportes más accesibles, atractivos y útiles para la comunidad educativa. Se ha tenido especial interés en los estudiantes con Necesidades Específicas de Apoyo Educativo (NEAE) y en este sentido la creación de materiales ha sido fundamentalmente audiovisual. Por otro lado, la gestión dichos materiales a través de repositorios universitarios (Universidad de Alicante y Universidad Miguel Hernández) y de un canal docente de YouTube (canal IDOi), para su ulterior difusión nacional e internacional a las distintas bases de datos y portales adecuados (OCW, blogs UA, VUALA, Blogs externos, etc.) que facilitarán su consulta. Los resultados y reflexiones finales presentan varios documentos convertidos a un formato amigable, visual y valioso para los estudiantes con NEAE, a la vez que se ha diseñado un protocolo de actuación para la elaboración de los mismos y creado un canal docente en YouTube

Home parenteral nutrition (HPN) registry in spain for the years 2007, 2008 and 2009 (Nadya-SENPE group)

Objetivo: Comunicar los datos del registro de Nutrición Parenteral Domiciliaria (NPD) del grupo de trabajo NADYA-SENPE de los años 2007, 2008 y 2009. Material y métodos: Recopilación de los datos del registro “on-line” introducidos por las Unidades responsables del seguimiento de la NPD desde el 1 de enero de 2007 al 31 de diciembre de 2009 dividido por años naturales. Resultados: Año 2007: Se registraron 133 pacientes con NPD (61 hombres y 72 mujeres), de 21 hospitales. La edad media de los 119 pacientes mayores de 13 años fue de 53,7 ± 14,9 años, y de 3,6 ± 3,6 años la de los 14 pacientes que no los superaban. La patología más frecuente fue la neoplasia (24%) seguida de las alteraciones de la motilidad intestinal y la enteritis posradiación (ambas 14%). En el 43% de los casos el motivo de indicación fue el síndrome de intestino corto, seguido de malabsorción (27%) y obstrucción intestinal (23%). Los catéteres más utilizados fueron los tunelizados (69%) y los reservorios subcutáneos (27%). Las complicaciones mas frecuentes fueron las sépticas relacionadas con el catéter con una tasa de 0,92 infecciones por cada mil días de NPD. La duración de la NPD fue superior a los dos años en el 50% de los casos. Al acabar el año seguía en activo el 71,4% de los pacientes; la muerte fue la principal causa de la finalización de la NPD (57,5%). El 26% de los pacientes se consideraron candidatos al trasplante intestinal. Año 2008: Se registraron 143 pacientes con NPD (62 hombres y 81mujeres), de 24 hospitales. La edad media de los 133 pacientes mayores de 13 años fue de 54,7 ± 13,9 años, y de 3,7 ± 0,6 años la de los 10 pacientes que no los superaban. La patología más frecuente fue la neoplasia (20%) seguida de la enteritis rádica (14%) y las alteraciones de la motilidad intestinal (13%). En el 44% de los casos el motivo de indicación fue el síndrome de intestino corto, seguido de malabsorción (28%) y obstrucción Nutriintestinal (20%). Los catéteres más utilizados fueron los tunelizados (60%) y los reservorios subcutáneos (29%). Las complicaciones mas frecuentes fueron las sépticas relacionadas con el catéter con una tasa de 0,50 infecciones por cada mil días de NPD. La duración de la NPD fue superior a los dos años en el 67% de los casos. Al acabar el año seguía en activo el 71,6% de los pacientes; la muerte fue la principal causa de la finalización de la NPD (52,4%). El 29% de los pacientes se consideraron candidatos al trasplante intestinal. Año 2009: Se registraron 158 pacientes con NPD (62 hombres y 96 mujeres), de 24 hospitales. La edad media de los 149 pacientes mayores de 13 años fue de 55,2 ± 13,0 años. La patología más frecuente fue la neoplasia (25%) seguida de la enteritis rádica (12%) y las alteraciones de la motilidad intestinal (11%). En el 42% de los casos el motivo de indicación fue el síndrome de intestino corto, seguido de malabsorción y obstrucción intestinal (ambas 23%). Los catéteres más utilizados fueron los tunelizados (60%) y los reservorios subcutáneos (36%). Las complicaciones mas frecuentes fueron las sépticas relacionadas con el catéter con una tasa de 0,67 infecciones por cada mil días de NPD. La duración de la NPD fue superior a los dos años en el 58% de los casos. Al acabar el año seguía en activo el 79,2% de los pacientes; el paso a alimentación oral fue la principal causa de la finalización de la NPD (48%). El 23% de los pacientes se consideraron candidatos a trasplante intestinal. Conclusiones: Se observa un aumento progresivo de los pacientes registrados respecto a años anteriores con una prevalencia muy variable según comunidades autónomas. La principal patología sigue siendo la neoplasia, que ocupa el primer lugar desde 2003. Se aprecia una disminución de las complicaciones sépticas relacionadas con el catéter en los dos últimos años, siendo la tasa de 2008 la más baja desde la creación del registroObjective: To report the data of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group for the years 2007, 2008 and 2009. Methodology: We compiled the data from the on-line registry introduced by the responsible Units for the monitoring of HPN from January 1st 2007 to December 31st 2009. Included fields were: age, sex, diagnosis and reason for HPN, access path, complications, beginning and end dates, complementary oral or enteral nutrition, activity level, autonomy degree, product and fungible material supply, withdrawal reason and intestinal transplant indication. Results: 2007: 133 patients with HPN were registered (61 males and 72 females), belonging to 21 hospitals. Average age for the 119 patients older than 13 years old was 53.7 ± 14.9 years, and 3.6 ± 3.6 y. for the 14 patients under 14 years old. Most frequent pathology was neoplasm (24%), followed by intestinal motility disorders and actinic enteritis (14% both). The reason for HPN provision was short bowel syndrome (43%), malabsorption (27%), and intestinal obstruction (23%). Tunnelled catheters were mostly used (69%), followed by implanted port-catheters (27%). Catheter related infections were the most frequent complications, with a rate of 0.92 episodes/103 HPN days. HPN was provided for more than two years in 50% of the cases. By the end of 2007, 71.4% of the patients remained active; exitus was the most frequent reason to end HPN (57.5%). 26% of the patients were eligible for intestinal transplant. 2008: 143 patients with HPN were registered (62 males and 81 females), belonging to 24 hospitals. Average age for the 133 patients older than 13 years old was 54.7 ± 13.9 years, and 3.7 ± 0.6 y. for the 10 patients under 14 years old. Most frequent pathology was neoplasm (20%), followed by actinic enteritis (14%) and intestinal motility disorders (13% ). The reason for HPN provision was short bowel syndrome (44%), malabsorption (28%), and intestinal obstruction (20%). Tunnelled catheters were mostly used (60%), followed by implanted port-catheters (29%). Catheter related infections were the most frequent complications, with a rate of 0.50 episodes/103 HPN days. HPN was provided for more than two years in 67% of the cases. By the end of 2008, 71.6% of the patients remained active; exitus was the most frequent reason to end HPN (52.4%). 29% of the patients were eligible for intestinal transplant. 2009: 158 patients with HPN were registered (62 males and 96 females), belonging to 24 hospitals. Average age for the 149 patients older than 13 years old was 55.2 ± 13.0 years. Most frequent pathology was neoplasm (25%), followed by actinic enteritis (12%) and intestinal motility disorders (11%). The reason for HPN provision was short bowel syndrome (42%), malabsorption, and intestinal obstruction (23% both). Tunnelled catheters were mostly used (60%), followed by implanted port-catheters (36%). Catheter related infections were the most frequent complications, with a rate of 0.67 episodes/103 HPN days. HPN was provided for more than two years in 58% of the cases. By the end of 2009, 79.2% of the patients remained active; full oral nutrition was the most frequent reason to end HPN (48%). 23% of the patients were eligible for intestinal transplant. Conclusions: We observe an increase in registered patients with respect to previous years, with a very different prevalence among regions. Neoplasia remains as the main pathology since 2003. We observe a decrease in catheter-related infections in the last two years, being the 2008 rate the smallest since the register’s beginning