El desarrollo de la atención multidisciplinar en la atención al cáncer

En el contexto de la llamada lucha contra el cáncer, la organización de los servicios sanitarios no resultó ser un objetivo europeo hasta 2007, con la Presidencia portuguesa del Consejo Europeo y tras la constatación de que las diferencias en supervivencia relativa entre países europeos debían atribuirse en parte a la organización y la calidad en la provisión de servicios. La prioridad establecida por el marco europeo focaliza con especial énfasis la atención multidisciplinar, un modelo organizativo que conlleva una redistribución de competencias y responsabilidades en torno a los profesionales con mayor potencial en el logro de la efectividad clínica. La visión europea que surge tras el esfuerzo en investigación y consenso sobre el rol y los objetivos que deben asumir los equipos de atención multidisciplinar es determinante en la configuración del modelo de atención actual, más integrado y mayormente capaz de responder a los retos de la creciente complejidad que presenta la atención al cáncer

Robot de Minisumo

Aquest document, que a continuació es mostra, tracta d’agrupar tots aquells aspectes que fan falta per poder realitzar un robot de lluita de minisumo. Tots aquells temes dels quals es van partir per elaborar aquest projecte es troben en aquest document de manera més extensa, amb les exposicions del perquè s’han pres certes decisions, però sense deixar de banda altres opcions que es poden donar i que, en un moment donat, podem utilitzar com alternativa equivalent. També consta de l’explicació de certs programes que s’utilitzen per facilitar a aquell qui llegeixi aquest projecte i tingui una base de la qual partir. A més a més, inclou esquemes amb les seves explicacions corresponents, el material que es pot trobar al mercat actualment i moltes més coses de gran interès

Estudi d’un sistema de control amb aprenentatge per reforç

Estudi d’una tècnica d’aprenentatge per reforç aplicada al disseny de controladors, i de les seves prestacions i característiques d’estabilitat, utilitzant com a proves diferents sistemes a controlar, els quals tenen característiques que els fan difícils de controlar, com la inestabilitat

Core communication components along the cancer care process: the perspective of breast cancer patients

This study sought to assess the impact of health care professional (HCP) communication on breast cancer patients across the acute care process as perceived by patients. Methodological approach was based on eight focus groups conducted with a sample of patients (n ¼ 37) drawn from 15 Spanish Regions; thematic analysis was undertaken using the National Cancer Institute (NCI) framework of HCP communication as the theoretical basis. Relevant results of this study were the identification of four main communication components: (1) reassurance in coping with uncertainty after symptom detection and prompt access until confirmed diagnosis; (2) fostering involvement before delivering treatments, by anticipating information on practical and emotional illness-related issues; (3) guidance on the different therapeutic options, through use of clinical scenarios; and, (4) eliciting the feeling of emotional exhaustion after ending treatments and addressing the management of potential treatment-related effects. These communication-related components highlighted the need for a comprehensive approach in this area of cancer car

Implementing a Cancer Fast-track programme between primary and specialised care in Catalonia(Spain): amixed methods study

BACKGROUND: The Cancer Fast-track Programme's aim was to reduce the time that elapsed between well-founded suspicion of breast, colorectal and lung cancer and the start of initial treatment in Catalonia (Spain). We sought to analyse its implementation and overall effectiveness. METHODS: A quantitative analysis of the programme was performed using data generated by the hospitals on the basis of seven fast-track monitoring indicators for the period 2006-2009. In addition, we conducted a qualitative study, based on 83 semistructured interviews with primary and specialised health professionals and health administrators, to obtain their perception of the programme's implementation. RESULTS: About half of all new patients with breast, lung or colorectal cancer were diagnosed via the fast track, though the cancer detection rate declined across the period. Mean time from detection of suspected cancer in primary care to start of initial treatment was 32 days for breast, 30 for colorectal and 37 for lung cancer (2009). Professionals associated with the implementation of the programme showed that general practitioners faced with suspicion of cancer had changed their conduct with the aim of preventing lags. Furthermore, hospitals were found to have pursued three specific implementation strategies (top-down, consensus-based and participatory), which made for the cohesion and sustainability of the circuits. CONCLUSION: The programme has contributed to speeding up diagnostic assessment and treatment of patients with suspicion of cancer, and to clarifying the patient pathway between primary and specialised care

Innovative regression-based methodology to assess the techno-economic performance of photovoltaic installations in urban areas

[EN] Households present a significant contribution in the national energy consumption, and photovoltaics (PV) has become an economically feasible technology that can play an important role to lower this consumption and the associated emissions. Nevertheless, there is still a gap between too in-depth technical models for detailed studies and what urban energy planners need, which are simpler, yet reliable techno-economical tools to select which roofs of city buildings are the best candidates for PV production. In order to face this gap, a multiple linear regression (MLR) model has been developed to determine the economic payback using dimensionless parameters. The methodology has been adopted in the city of Valencia (Spain) for a large sample of multi-storey buildings, which are the most common typology. The approach has a high replicability since it can be applied for different countries. The MLR model provides a payback root mean squared error (RMSE) of 0.48 years in comparison with a complex techno-economic model which was previously developed and validated with the software System Advisor Model (SAM). The variables which have a bigger weight in the payback are the shadow losses and the power unit cost due to the economy of scale. With the current Spanish regulation, PV installations on multi-storey buildings can reach paybacks of around 7-15 years and the best option is to have large economies of scales together with a low energy surplus.This study was developed owing to the support provided by the Chair of Urban Energy Transition of the Universitat Politecnica de Valencia and the foundation Las Naves. Additionally, this work was supported by The Energy Office of Valencia and the Statistics Office of the Valencia City Council, who collaborated by providing the data of the PV facility for the validation and their recommendations on the statistical analysis.Fuster-Palop, E.; Prades-Gil, C.; Masip, X.; Viana-Fons, JD.; Payá-Herrero, J. (2021). Innovative regression-based methodology to assess the techno-economic performance of photovoltaic installations in urban areas. Renewable and Sustainable Energy Reviews. 149:1-15. https://doi.org/10.1016/j.rser.2021.111357S11514

Patients' and rheumatologists' preferences for the attributes of biological agents used in the treatment of rheumatic diseases in Spain

Purpose: To define importance values assigned to attributes of biological agents (BAs) by Spanish patients with rheumatic diseases (rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis) and rheumatologists. Patients and methods: This was an observational, cross-sectional design based upon a rank-based full-profile conjoint analysis. A literature review and four focus groups were undertaken to identify attributes and levels. An orthogonal matrix, combining the selected levels of attributes, was used to define scenarios. Participants ranked eight scenarios from 1 (most preferred) to 8 (least preferred). The relative importance (RI) of attributes was calculated. Multivariate regression analysis was performed to identify the characteristics that influenced the values of RI. A total of 488 patients (male 50.9%, mean age 50.6 [standard deviation {SD} 12.06] years, rheumatoid arthritis 33.8%, ankylosing spondylitis 32.4%, psoriatic arthritis 33.8%; mean time since diagnosis 12.6 [SD 8.2] years) and 136 rheumatologists (male 50.4%, mean age 46.4 [SD 9.1] years, mean time of practice 16.7 [SD 8.8] years) participated. Results: The ideal BAs for patients and physicians, respectively, should allow pain relief and improvement of functional capacity (RI 39% and 44.7%), with low risk of adverse events (RI 24.9% and 30.5%), a long time prior to perceiving the need for a new dose (RI 16.4% and 12.4%), and self-administration at home (RI 19.7% and 12.5%), as identified through their preferences. Conclusion: Although efficacy and safety are paramount for patients and rheumatologists to make a choice regarding BAs, the need for a low frequency of administration and the administration method also play a role as preference attributes for BAs

Socioeconomic Status and Distance to Reference Centers for Complex Cancer Diseases: A Source of Health Inequalities? A Population Cohort Study Based on Catalonia (Spain)

The centralization of complex surgical procedures for cancer in Catalonia may have led to geographical and socioeconomic inequities. In this population-based cohort study, we assessed the impacts of these two factors on 5-year survival and quality of care in patients undergoing surgery for rectal cancer (2011-12) and pancreatic cancer (2012-15) in public centers, adjusting for age, comorbidity, and tumor stage. We used data on the geographical distance between the patients' homes and their reference centers, clinical patient and treatment data, income category, and data from the patients' district hospitals. A composite 'textbook outcome' was created from five subindicators of hospitalization. We included 646 cases of pancreatic cancer (12 centers) and 1416 of rectal cancer (26 centers). Distance had no impact on survival for pancreatic cancer patients and was not related to worse survival in rectal cancer. Compared to patients with medium-high income, the risk of death was higher in low-income patients with pancreatic cancer (hazard ratio (HR) 1.46, 95% confidence interval (CI) 1.15-1.86) and very-low-income patients with rectal cancer (HR 5.14, 95% CI 3.51-7.52). Centralization was not associated with worse health outcomes in geographically dispersed patients, including for survival. However, income level remained a significant determinant of survival