Sarcomas de partes blandas. Análisis de 42 casos

El objetivo de este estudio es valorar el pronóstico a largo plazo de una serie de pacientes tratados en nuestro hospital en relación con diversos factores clínicos, diagnósticos y terapéuticos que podrían condicionarlo. Se revisaron 123 pacientes tratado por tumores malignos de partes blandas entre los años 1979 y 1999, de estos solo 42 cumplieron las características para incluirles en nuestro estudio. Se valoró su evolución teniendo en cuenta las variables pronosticas identificadas en trabajos previamente publicados y nuestra propia experiencia y se realizó el estudio estadístico de las mismas. En el análisis estadístico del estudio se utilizó el programa SPSS versión 8.0WIN y se realizó el análisis de supervivencia mediante el método de Kaplan-Meier. El tiempo de supervivencia total descrito según este método para el total de los casos estudiados presenta una mediana de 33 meses con un error estándar de 8 y un intervalo de confianza del 95% de (17,49), el tiempo libre de enfermedad presenta una mediana de 9 meses con un error estándar de 2 y un intervalo de confianza del 95% de (6,12) y el tiempo de aparición de metástasis presenta una mediana de 26 meses con un error estándar de 5 y un intervalo de confianza del 95% de (17,35). A su vez se realizó el análisis bivariante de las múltiples variables pronosticas. El gran número de variables y la dispersión de la muestra hacen aconsejable estudios multicéntricos prospectivos más numerosos para obtener conclusiones definitivas sobre este tipo de tumores.The aim of this study is to evaluate the long-term prognosis of a series of patients treated in our hospital with regard to various clinical, diagnostic and therapeutic factors. A total of 123 patients who had been treated for malignant soft tissue tumours between 1979 and 1999 were reviewed. Of these, only 42 fulfilled the requirements to be included in our study. The outcome was evaluated taking into account prognostic variables identified in previously published studies and our own experience, and a statistical study of these factors as carried out with the Kaplan-Meier survival analysis method. The total survival time for all the cases studied was 33+8 (median + SE) months with a 95% confidence interval of 17.49 months. The time free of illness was 9+2 (median + SE) months with a 95% confidence interval of 6.12 months. The time-period until metastasis appeared was 26+5 (median + SE) months with a 95% confidence interval of 17.35 months. At the same time, the bivariant analysis of the many prognostic variables was performed. The high number of variables and the dispersion of the sample group suggest that it would be advisable to carry out more prospective, multicentric studies to reach definitive conclusions about this type of tumour

Multiple health behaviour change primary care intervention for smoking cessation, physical activity and healthy diet in adults 45 to 75 years old (EIRA study): a hybrid effectiveness-implementation cluster randomised trial

Methods: A cluster randomised effectiveness-implementation hybrid trial-type 2 with two parallel groups was conducted in 25 Spanish Primary Health Care (PHC) centres (3062 participants): 12 centres (1481 participants) were randomised to the intervention and 13 (1581 participants) to the control group (usual care). The intervention was based on the Transtheoretical Model and focused on all target behaviours using individual, group and community approaches. PHC professionals made it during routine care. The implementation strategy was based on the Consolidated Framework for Implementation Research (CFIR). Data were analysed using generalised linear mixed models, accounting for clustering. A mixed-methods data analysis was used to evaluate implementation outcomes (adoption, acceptability, appropriateness, feasibility and fidelity) and determinants of implementation success. Results: 14.5% of participants in the intervention group and 8.9% in the usual care group showed a positive change in two or all the target behaviours. Intervention was more effective in promoting dietary behaviour change (31.9% vs 21.4%). The overall adoption rate by professionals was 48.7%. Early and final appropriateness were perceived by professionals as moderate. Early acceptability was high, whereas final acceptability was only moderate. Initial and final acceptability as perceived by the participants was high, and appropriateness moderate. Consent and recruitment rates were 82.0% and 65.5%, respectively, intervention uptake was 89.5% and completion rate 74.7%. The global value of the percentage of approaches with fidelity ≥50% was 16.7%. Eight CFIR constructs distinguished between high and low implementation, five corresponding to the Inner Setting domain. Conclusions: Compared to usual care, the EIRA intervention was more effective in promoting MHBC and dietary behaviour change. Implementation outcomes were satisfactory except for the fidelity to the planned intervention, which was low. The organisational and structural contexts of the centres proved to be significant determinants of implementation effectiveness

Implementación en la UCM del Grado en Estudios Europeos / Bachelor in European Studies en el marco de la alianza europea de universidades UNA EUROPA

El presente proyecto de innovación ha tenido por objetivo la implementación en la Universidad Complutense de Madrid del Nuevo Grado en Estudios Europeos / Bachelor of European Studies (BAES) creado en el marco de la nueva alianza europea de universidades UNA EUROPA integrada por la Universidad Complutense de Madrid, la Universidad de la Sorbona (París – I), Universidad Libre de Berlín, Universidad de Bolonia, Universidad Jaguelónica de Cracovia, Universidad de Helsinki, Universidad Católica de Lovaina, y Universidad de Edimburgo

Major Adverse Cardiovascular Events in Coronary Type 2 Diabetic Patients: Identification of Associated Factors Using Electronic Health Records and Natural Language Processing

Patients with Type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) are at high risk of developing major adverse cardiovascular events (MACE). This is a multicenter, retrospective, and observational study performed in Spain aimed to characterize these patients in a real-world setting. Unstructured data from the Electronic Health Records were extracted by EHRead (R), a technology based on Natural Language Processing and machine learning. The association between new MACE and the variables of interest were investigated by univariable and multivariable analyses. From a source population of 2,184,662 patients, we identified 4072 adults diagnosed with T2DM and CAD (62.2% male, mean age 70 +/- 11). The main comorbidities observed included arterial hypertension, hyperlipidemia, and obesity, with metformin and statins being the treatments most frequently prescribed. MACE development was associated with multivessel (Hazard Ratio (HR) = 2.49) and single coronary vessel disease (HR = 1.71), transient ischemic attack (HR = 2.01), heart failure (HR = 1.32), insulin treatment (HR = 1.40), and percutaneous coronary intervention (PCI) (HR = 2.27), whilst statins (HR = 0.73) were associated with a lower risk of MACE occurrence. In conclusion, we found six risk factors associated with the development of MACE which were related with cardiovascular diseases and T2DM severity, and treatment with statins was identified as a protective factor for new MACE in this study

Impact of Advanced Age on the Incidence of Major Adverse Cardiovascular Events in Patients with Type 2 Diabetes Mellitus and Stable Coronary Artery Disease in a Real-World Setting in Spain

Patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) without myocardial infarction (MI) or stroke are at high risk for major cardiovascular events (MACEs). We aimed to provide real-world data on age-related clinical characteristics, treatment management, and incidence of major cardiovascular outcomes in T2DM-CAD patients in Spain from 2014 to 2018. We used EHRead (R) technology, which is based on natural language processing and machine learning, to extract unstructured clinical information from electronic health records (EHRs) from 12 hospitals. Of the 4072 included patients, 30.9% were younger than 65 years (66.3% male), 34.2% were aged 65-75 years (66.4% male), and 34.8% were older than 75 years (54.3% male). These older patients were more likely to have hypertension (OR 2.85), angina (OR 1.64), heart valve disease (OR 2.13), or peripheral vascular disease (OR 2.38) than those aged <65 years (p < 0.001 for all comparisons). In general, they were also more likely to receive pharmacological and interventional treatments. Moreover, these patients had a significantly higher risk of MACEs (HR 1.29; p = 0.003) and ischemic stroke (HR 2.39; p < 0.001). In summary, patients with T2DM-CAD in routine clinical practice tend to be older, have more comorbidities, are more heavily treated, and have a higher risk of developing MACE than is commonly assumed from clinical trial data

Implementación de mejoras en la información web a los usuarios de la Oficina de Movilidad Internacional: Hacia una movilidad internacional sin papeles.

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Puesta en marcha del Doble Grado Internacional en Derecho UCM - Sorbona en el marco de la alianza europea de universidades UNA EUROPA

Implementación de mejoras que potencien el Doble Grado Internacional en Derecho impartido conjuntamente entre la UCM y la Universidad de la Sorbona y que esta doble titulación internacional refuerce el papel de la UCM en la alianza europea UNA EUROP

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Quality assurance in specialized headache units in Spain : an observational prospective study

To assess the quality of the therapeutic approach in Specialized Headache Units in Spain. An observational (prospective) study was conducted. Anonymized data of 313 consecutive patients during a defined period of time were analyzed and a comparison of performance in 13 consensual quality indicators between Specialized Headache Units and neurology consultations was calculated. Specialized Units and neurology consultations represented the type of provision that Spaniards receive in hospitals. The consensus benchmark standard was reached for 8/13 (61%) indicators. Specialized Headache Units performed better in the indicators, specifically in relation to accessibility, equity, safety, and patient satisfaction. Patients attended in Specialized Headache Units had more complex conditions. Although there is variability among Specialized Headache Units, the overall quality was generally better than in traditional neurology consultations in Spain