Diagnóstico: cáncer. ¿Queremos conocer la verdad?

ObjetivoConocer los deseos de información y otras actitudes ante el diagnóstico de cáncerDiseñoEstudio descriptivo transversaEmplazamientoCentros de Salud de Irún, Oñati y Asteasu en GipuzkoaParticipantesDe las citaciones a las 19 consultas durante marzo-mayo del 2002 se obtuvo una muestra aleatoria, prospectiva y sistemática, estratificada por cupos (n=725). Se administró una encuestamodificada de Fernández Díaz en la que se recogieron los datos personales y 8preguntas con respuestas cerradas: aspectos de comunicación (5 ítems) y actitudes relacionadas con la muerte (3 ítems)ResultadosEl 81,3% (IC del 95%, 78,4- 84,1) quiere conocer su diagnóstico. El 68,9% (IC del 95%, 65,5–72,2) elige al médico para comunicarlo. De éstos, el 36,6%, al especialista, y el 26,6%, al médicode familia. Si el afectado es un familiar, el 46,6% (IC del 95%, 42,9–50,2) se lo dirían siempre, sólo si él lo pregunta el 38,6% (ICdel 95%, 35–42,1) y nunca el 9,6% (IC del 95%, 7,4–11,7). El 49,3% (IC del 95%,45,6–52,9) preferiría morir en casa. Para el 44% (IC del 95%, 40,3–47,6) el dolor es el mayor temorConclusionesLa mayoría de la población quiere que se le informe de su diagnóstico, sin que el hábitat urbano o rural o la experiencia de haber tenido familiares con cáncer modifique la opinión. Si el afectadode cáncer es un familiar, son muy pocos los partidarios de no decírselo nunca. Eligen almédico para transmitir la información,prefieren morir en casa y el dolor es lamayor preocupaciónObjectivesTo find people's desire for information and their other attitudes when faced with a cancer diagnosisDesignTransversal, descriptive studySettingIrun, Oñati and Asteasu Health Centres, Gipuzkoa, SpainParticipantsFrom the appointments for 19 clinics in March-May 2002, a randomised, prospective and systematic sample, stratified by lists, was extracted (n=725). A modified Fernández Díaz questionnaire was administered. It had personal details and 8questions with closed replies on aspects of communication (5) and attitudes to death (3Results81.3% (95% CI, 78.4–84.1) wanted to know their diagnosis. 68.9% (95% CI, 65.5- 72.2) chose the doctor to tell them. Of these, 6.6% chose the specialist and 26.6%, thegeneral practitioner. If the person affected was a family member, 46.6% (95% CI, 42.9–50.2) would always tell the person; 38.6% (95% CI, 35–42.1), only if the person asked; and 9.6%, never (95% CI, 7.4–11.7). 49.3% (95% CI, 45.6–52.9) would prefer to die at home. The greatest fear for 44% (95% CI, 40.3–47.6) waspainConclusionsMost people want to be informed of their diagnosis. Neither an urban or rural environment nor having had family members with cancer affects their view. If the personaffected by cancer is a family member, very few people favour not telling him/her at all. Sufferers want the doctor to tell them the information, prefer to die at home and pain is what worries them mos

Evaluación de la calidad de comunicación entre niveles asistenciales mediante el documento interconsulta

ObjetivosEvaluar la calidad y mejora de cumplimentación de los documentos de interconsulta en el equipo de atención primaria (EAP).DiseñoCiclo completo de calidad.EmplazamientoAtención primaria (AP).Componentes de la evaluaciónDimensión estudiada: calidad científico-técnica. Sujetos: todos los documentos de interconsulta (DI-1) dirigidos por los médicos de AP del centro de salud de Irún Centro a atención especializada durante 15 días, 223 DI-1 para la evaluación en abril de 1998 y 287 para la reevaluación en octubre 1998. Tipo de evaluación: retrospectiva. Fuente de datos: documentos interconsulta e historias clínicas. Criterios: explícitos y normativos. Medidas correctoras: educativas (discusión de resultados en reunión del EAP).ResultadosEn la reevaluación se observó una mejoría estadísticamente significativa: datos de filiación (91,5-96,8%), legibilidad (86-92,7%), antecedentes y/o medicación habitual (35,9-50%) y sintomatología (77,8-87,2%). Por niveles de calidad se ha pasado en los buenos del 20,6 al 42,5% y en los malos del 40,8 al 33,4%. Obtuvimos respuesta en un 22,2% de nuestras derivaciones. La falta de respuesta se produce en un 34% por no haber informe del especialista, un 47,8% se atribuyen al paciente o al circuito y el 18% de los pacientes está pendiente de pruebas.ConclusionesLa información proporcionada en los DI-1 ha mejorado significativamente después del ciclo de calidad. Conocer nuestra práctica habitual de trabajo sirve como estimulo de mejora. Los criterios que peor cumplimos son: referencia a antecedentes personales y/o medicación habitual, exploración física y medidas terapéuticas empleadas. Gran perdida de información en la respuesta a nuestras derivaciones.ObjectivesTo evaluate the quality and improvement of compliance in the inter-consultation documents of the primary care team (PCT).DesignEntire care cycle.SettingPrimary care (PC).MeasurementsDimension studied: scientific-technical quality. Subjects: all the inter-consultation documents (ID-1) sent by PC doctors from Irun Health Centre to specialist clinics over a 15-day period. 223 ID-1 for evaluation in April 1998, and 287 for re-evaluation in October 1998. Type of evaluation: retrospective. Source of data: inter-consultation documents and clinical records. Criteria: explicit and standard. Corrective measures: educational (discussion of results in meeting of the PCT).ResultsA statistically significant improvement was found at the re-evaluation: basic personal details (91.5%-96.8%), legibility (86%-92.7%), medical history and/or customary medication (35.9%-50%) and symptoms (77.8%-87.2%). Good quality levels rose from 20.6% to 42.5%; and bad quality levels fell from 40.8% to 33.4%. 22.2% of our referrals received a reply. 34% of the lack of replies was because of no report from the specialist, 47.8% were attributed to the patient or circuit, and 18% of the patients were awaiting test results.ConclusionsThe information supplied in the ID-1 improved significantly after the quality cycle. Knowing our habitual working practice can serve to stimulate improvement. The criteria we complied with least were: reference to personal antecedents and/or habitual medication, physical examination, and therapeutic measures employed. There was a huge loss of information in the replies to our referrals

Rules, Standards, and the Internal Point of View

Large scale structure and cosmolog

The Effect of a Physical Activity Program on the Total Number of Primary Care Visits in Inactive Patients: A 15-Month Randomized Controlled Trial

Abstract Background: Effective promotion of exercise could result in substantial savings in healthcare cost expenses in terms of direct medical costs, such as the number of medical appointments. However, this is hampered by our limited knowledge of how to achieve sustained increases in physical activity. Objectives: To assess the effectiveness of a Primary Health Care (PHC) based physical activity program in reducing the total number of visits to the healthcare center among inactive patients, over a 15-month period. Research Design: Randomized controlled trial. Subjects: Three hundred and sixty-two (n = 362) inactive patients suffering from at least one chronic condition were included. One hundred and eighty-three patients (n = 183; mean (SD); 68.3 (8.8) years; 118 women) were randomly allocated to the physical activity program (IG). One hundred and seventy-nine patients (n = 179; 67.2 (9.1) years; 106 women) were allocated to the control group (CG). The IG went through a three-month standardized physical activity program led by physical activity specialists and linked to community resources. Measures: The total number of medical appointments to the PHC, during twelve months before and after the program, was registered. Self-reported health status (SF-12 version 2) was assessed at baseline (month 0), at the end of the intervention (month 3), and at 12 months follow-up after the end of the intervention (month 15). Results: The IG had a significantly reduced number of visits during the 12 months after the intervention: 14.8 (8.5). The CG remained about the same: 18.2 (11.1) (P = .002). Conclusions: Our findings indicate that a 3-month physical activity program linked to community resources is a shortduration, effective and sustainable intervention in inactive patients to decrease rates of PHC visits. Trial Registration: ClinicalTrials.gov NCT0071483

Antibody response in patients admitted to the hospital with suspected SARS-CoV-2 infection: results from a multicenter study across Spain

Aim: To evaluate the serological response against SARS-CoV-2 in a multicenter study representative of the Spanish COVID pandemic. Methods: IgG and IgM + IgA responses were measured on 1466 samples from 1236 Spanish COVID-19 patients admitted to the hospital, two commercial ELISA kits (Vircell SL, Spain) based on the detection of antibodies against the viral spike protein and nucleoprotein, were used. Results: Approximately half of the patients presented antibodies (56.8% were IgM + IgA positive and 43.0% were IgG positive) as soon as 2 days after the first positive PCR result. Serological test positivity increased with time from the PCR test, and 10 days after the first PCR result, 91.5% and 88.0% of the patients presented IgM + IgA and IgG antibodies, respectively. Conclusion: The high values of sensitivity attained in the present study from a relatively early period of time after hospitalization support the use of the evaluated serological assays as supplementary diagnostic tests for the clinical management of COVID-19

Incidence, clinical characteristics and management of inflammatory bowel disease in Spain: large-scale epidemiological study

(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD—Crohn’s disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)—during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100, 000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31–56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients, p < 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

J-PLUS: The javalambre photometric local universe survey

ABSTRACT: TheJavalambrePhotometric Local UniverseSurvey (J-PLUS )isanongoing 12-band photometricopticalsurvey, observingthousands of squaredegrees of theNorthernHemispherefromthededicated JAST/T80 telescope at the Observatorio Astrofísico de Javalambre (OAJ). The T80Cam is a camera with a field of view of 2 deg2 mountedon a telescopewith a diameter of 83 cm, and isequippedwith a uniquesystem of filtersspanningtheentireopticalrange (3500–10 000 Å). Thisfiltersystemis a combination of broad-, medium-, and narrow-band filters, optimallydesigned to extracttherest-framespectralfeatures (the 3700–4000 Å Balmer break region, Hδ, Ca H+K, the G band, and the Mg b and Ca triplets) that are key to characterizingstellartypes and delivering a low-resolutionphotospectrumforeach pixel of theobservedsky. With a typicaldepth of AB ∼21.25 mag per band, thisfilter set thusallowsforanunbiased and accuratecharacterization of thestellarpopulation in our Galaxy, itprovidesanunprecedented 2D photospectralinformationforall resolved galaxies in the local Universe, as well as accuratephoto-z estimates (at the δ z/(1 + z)∼0.005–0.03 precisionlevel) formoderatelybright (up to r ∼ 20 mag) extragalacticsources. Whilesomenarrow-band filters are designedforthestudy of particular emissionfeatures ([O II]/λ3727, Hα/λ6563) up to z < 0.017, theyalsoprovidewell-definedwindowsfortheanalysis of otheremissionlines at higherredshifts. As a result, J-PLUS has thepotential to contribute to a widerange of fields in Astrophysics, both in thenearbyUniverse (MilkyWaystructure, globular clusters, 2D IFU-likestudies, stellarpopulations of nearby and moderate-redshiftgalaxies, clusters of galaxies) and at highredshifts (emission-line galaxies at z ≈ 0.77, 2.2, and 4.4, quasi-stellarobjects, etc.). Withthispaper, wereleasethefirst∼1000 deg2 of J-PLUS data, containingabout 4.3 millionstars and 3.0 milliongalaxies at r <  21mag. With a goal of 8500 deg2 forthe total J-PLUS footprint, thesenumbers are expected to rise to about 35 millionstars and 24 milliongalaxiesbytheend of thesurvey.Funding for the J-PLUS Project has been provided by the Governments of Spain and Aragón through the Fondo de Inversiones de Teruel, the Spanish Ministry of Economy and Competitiveness (MINECO; under grants AYA2017-86274-P, AYA2016-77846-P, AYA2016-77237-C3-1-P, AYA2015-66211-C2-1-P, AYA2015-66211-C2-2, AYA2012-30789, AGAUR grant SGR-661/2017, and ICTS-2009-14), and European FEDER funding (FCDD10-4E-867, FCDD13-4E-2685

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P &lt; 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P &lt; 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk