Quintana J.M.,Hospital Galdakao Usansolo |
Gonzalez N.,Hospital Galdakao Usansolo |
Anton-Ladislao A.,Hospital Galdakao Usansolo |
Redondo M.,Hospital Costa del Sol |
And 60 more authors.
BMC Cancer | Year: 2016
Background: Colorectal cancers are one of the most common forms of malignancy worldwide. But two significant areas of research less studied deserve attention: health services use and development of patient stratification risk tools for these patients. Methods: Design: a prospective multicenter cohort study with a follow up period of up to 5 years after surgical intervention. Participant centers: 22 hospitals representing six autonomous communities of Spain. Participants/Study population: Patients diagnosed with colorectal cancer that have undergone surgical intervention and have consented to participate in the study between June 2010 and December 2012. Variables collected include pre-intervention background, sociodemographic parameters, hospital admission records, biological and clinical parameters, treatment information, and outcomes up to 5 years after surgical intervention. Patients completed the following questionnaires prior to surgery and in the follow up period: EuroQol-5D, EORTC QLQ-C30 (The European Organization for Research and Treatment of Cancer quality of life questionnaire) and QLQ-CR29 (module for colorectal cancer), the Duke Functional Social Support Questionnaire, the Hospital Anxiety and Depression Scale, and the Barthel Index. The main endpoints of the study are mortality, tumor recurrence, major complications, readmissions, and changes in health-related quality of life at 30 days and at 1, 2, 3 and 5 years after surgical intervention. Statistical analysis: In relation to the different endpoints, predictive models will be used by means of multivariate logistic models, Cox or linear mixed-effects regression models. Simulation models for the prediction of discrete events in the long term will also be used, and an economic evaluation of different treatment strategies will be performed through the use of generalized linear models. Discussion: The identification of potential risk factors for adverse events may help clinicians in the clinical decision making process. Also, the follow up by 5 years of this large cohort of patients may provide useful information to answer different health services research questions. Trial registration: ClinicalTrials.gov Identifier: NCT02488161. Registration date: June 16, 2015. © 2016 The Author(s).
Arboleya L.,Hospital San Agustin |
Diaz-Curiel M.,Fundacion Jimenez Diaz |
Del Rio L.,Centro Medico CETIR |
Blanch J.,IMAS Hospital del Mar |
And 7 more authors.
Aging Clinical and Experimental Research | Year: 2010
Background and aims: Vertebral fracture (VF) is the most common complication of osteoporosis. However, more than half of all VF are asymptomatic and may go unnoticed, even in patients with osteoporosis. Our aim was to assess the prevalence of VF in postmenopausal women with osteopenic lumbar densitometry by means of vertebral morphometry, using the MorphoXpress® software. Patients and methods: This was an epidemiological, cross-sectional, multicenter study conducted among 289 postmenopausal women (>1 year of amenorrhoea), diagnosed with lumbar osteopenia (not due to chronic treatment with corticosteroids or immobilization). Vertebral deformities ≥20% were considered as VF. Results: Demographic and clinical characteristics showed mean age (±SD) 64±9 years, body mass index 27±5 kg/m 2, and time from diagnosis of 2±3 years. A total of 25% of subjects had a family history of osteoporotic fracture in first-degree relatives, and 23% had previous fragility fracture. The prevalence of VF was 50% (CI 95% 44-56), the most frequent being the dorsal wedge (34%). Previous fragility fracture was a risk factor for VF (OR 3.13, p=0.0004). A total of 76.5% of patients were receiving treatment, mainly calcium and vitamin D supplements (70%) and bisphosphonates (27%). Conclusions: MorphoXpress® revealed that 50% of postmenopausal women with osteopenic lumbar densitometry showed VF. This result is important since only 7% of all evaluated subjects had previously been diagnosed with VF. ©2010, Editrice Kurtis.
Factors influencing the physician disposition to treat with a therapy with proven but low efficacy: The case of endarterectomy for severe asymptomatic carotid stenosis [¿Qué factores influyen en la predisposición terapéutica ante tratamientos de eficacia demostrada pero discreta? El caso de la revascularización en la estenosis carotídea grave asintomática]
Calsina Juscafresa L.,IMAS Hospital del Mar |
Clara Velasco A.,IMAS Hospital del Mar |
Llort Pont C.,IMAS Hospital del Mar |
Ois Santiago A.,IMAS Hospital del Mar |
Vidal-Barraquer Mayol F.,IMAS Hospital del Mar
Angiologia | Year: 2010
Objective. Considering as "clinically relevant" a therapy with proven albeit low -quantitatively-efficacy may depend, in practice, on atypical factors. This study evaluated the predisposition to treat (PT) in a theoretical and "blind" scenario based on the benefits and risks associated with endarterectomy in severe asymptomatic carotid stenosis. Participants and measurements. Participants: 100 physicians randomly selected from a teaching hospital (mean age: 34.6 years, 48 % male, 54 % staff, 63 % non-surgical speciality). Measurements: structured multidisciplinary survey, based on the aforementioned scenario, evaluating (Visual Analogic Scale) the influence of patient, treatment or professional characteristics on PT. Results. Linear relationships between PT and younger age of patient (p < 0.001), lower treatment invasiveness (p < 0.001) and higher empirical support (p < 0.001) were observed. No statistically significant differences were observed between non-surgical and surgical specialists. Staff and male physicians showed higher PT levels at any patient age (staff + male, p < 0.05) and treatment invasiveness (staff, p < 0.01; male, p < 0.025). PT levels were also influenced by: a) residents favouring treatments with higher teaching interest (p < 0.04); b) staff promoting treatments according to their personal experience (p < 0.018); c) non-surgical specialists favouring treatments with scientific-technical interest (p < 0.041). The level of patient comprehension (p < 0.061) and VIPs (p < 0.065) marginally influenced PT. Conclusions. The proven but low efficacy of some treatments, such as carotid endarterectomy for severe asymptomatic stenosis, seems to be due to contingent factors influencing the final decision to treat. The identification of subgroups of patients with higher therapeutic benefit would probably decrease the importance of those factors in clinical decision-making. © 2010 FSEACV. Published by Elsevier España, S.L. All rights reserved.