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Offersen B.V.,Aarhus University Hospital | Boersma L.J.,Maastricht University | Kirkove C.,Catholic University of Leuven | Hol S.,Institute Verbeeten | And 16 more authors.
Radiotherapy and Oncology | Year: 2015

Background and purpose Delineation of clinical target volumes (CTVs) is a weak link in radiation therapy (RT), and large inter-observer variation is seen in breast cancer patients. Several guidelines have been proposed, but most result in larger CTVs than based on conventional simulator-based RT. The aim was to develop a delineation guideline obtained by consensus between a broad European group of radiation oncologists. Material and methods During ESTRO teaching courses on breast cancer, teachers sought consensus on delineation of CTV through dialogue based on cases. One teacher delineated CTV on CT scans of 2 patients, followed by discussion and adaptation of the delineation. The consensus established between teachers was sent to other teams working in the same field, both locally and on a national level, for their input. This was followed by developing a broad consensus based on discussions. Results Borders of the CTV encompassing a 5 mm margin around the large veins, running through the regional lymph node levels were agreed, and for the breast/thoracic wall other vessels were pointed out to guide delineation, with comments on margins for patients with advanced breast cancer. Conclusion The ESTRO consensus on CTV for elective RT of breast cancer, endorsed by a broad base of the radiation oncology community, is presented to improve consistency. © 2014 Elsevier Ireland Ltd. All rights reserved.

PubMed | Autonomous University of Barcelona, University of Zaragoza, Hospital San Pedro, Hospital Universitario Insular Of Gran Canaria and 4 more.
Type: | Journal: The American journal of cardiology | Year: 2017

Familial hypercholesterolemia (FH) is characterized by high low-density lipoprotein (LDL) cholesterol with co-dominant transmission and high risk of cardiovascular disease (CVD), although with high variability among subjects. Currently, CVD stratification tools for heterozygous FH (HeFH) are not available. A definition of severe HeFH has been recently proposed by the International Atherosclerosis Society (IAS), but it has not been validated. Our study aims to see clinical characteristics and prevalence of CVD in subjects defined as severe HeFH by IAS criteria. Probable or definite HeFH introduced in the Dyslipidemia Registry of Spanish Arteriosclerosis Society were analyzed by the IAS criteria. Univariate and multivariate analysis was used to assess the association of CVD with the IAS criteria. About 1,732 HeFH cases were analyzed. Severe HeFH had higher prevalence of familial history of CVD, personal history of tendon xanthomas, LDL cholesterol, and CVD than nonsevere HeFH. A total of 656 (77.1%) and 441 (50.1%) of men and women, respectively, fulfilled the IAS criteria of severe HeFH. In the univariate analysis, subjects defined as severe HeFH showed odds ratio 3.016 (95% CI 3.136 to 4.257, p <0.001) for CVD. However, when traditional risk factors were included in the multivariate analysis, only the presence of cholesterol >400mg/dl had a statistically significant association with CVD odds ratio 8.76 (95% CI 3.90 to 19.69, p <0.001). In conclusion, the IAS definition of severe HeFH is not significantly associated with CVD when adjusted for classic risk factors. Risk stratification in HeFH is an important issue, but the proposed criteria do not seem to solve this problem.

Juanola-Falgarona M.,Rovira i Virgili University | Juanola-Falgarona M.,Institute Salut Carlos III | Salas-Salvado J.,Rovira i Virgili University | Salas-Salvado J.,Institute Salut Carlos III | And 13 more authors.
American Journal of Clinical Nutrition | Year: 2014

Background: Low-glycemic index (GI) diets have been proven to have beneficial effects in such chronic conditions as type 2 diabetes, ischemic heart disease, and some types of cancer, but the effect of low-GI diets on weight loss, satiety, and inflammation is still controversial. Objective: We assessed the efficacy of 2 moderate-carbohydrate diets and a low-fat diet with different GIs on weight loss and the modulation of satiety, inflammation, and other metabolic risk markers. Design: The GLYNDIET study is a 6-mo randomized, parallel, controlled clinical trial conducted in 122 overweight and obese adults. Participants were randomly assigned to one of the following 3 isocaloric energy-restricted diets for 6 mo: 1) a moderate-carbohydrate and high-GI diet (HGI), 2) a moderate-carbohydrate and low-GI diet (LGI), and 3) a low-fat and high-GI diet (LF). Results: At weeks 16 and 20 and the end of the intervention, changes in body mass index (BMI; in kg/m2) differed significantly between intervention groups. Reductions in BMI were greater in the LGI group than in the LF group, whereas in the HGI group, reductions in BMI did not differ significantly from those in the other 2 groups (LGI: 22.45 ± 0.27; HGI: 22.30 ± 0.27; LF: 21.43 ± 0.27; F = 4.616, P = 0.012; pairwise comparisons: LGI compared with HGI, P = 1.000; LGI compared with LF, P = 0.016; HGI compared with LF, P = 0.061). The decrease in fasting insulin, homeostatic model assessment of insulin resistance, and homeostatic model assessment of β cell function was also significantly greater in the LGI group than in the LF group (P <0.05). Despite this tendency for a greater improvement with a low-GI diet, the 3 intervention groups were not observed to have different effects on hunger, satiety, lipid profiles, or other inflammatory and metabolic risk markers. Conclusion: A low-GI and energy-restricted diet containing moderate amounts of carbohydrates may be more effective than a high-GI and low-fat diet at reducing body weight and controlling glucose and insulin metabolism. This trial was registered at Current Controlled Trials (www.controlled-trials.com) as ISRCTN54971867. © 2014 American Society for Nutrition.

Sabater S.,Complejo Hospitalario Universitario Of Albacete Chua | Sevillano M.M.,Complejo Hospitalario Universitario Of Albacete Chua | Andres I.,Complejo Hospitalario Universitario Of Albacete Chua | Berenguer R.,Complejo Hospitalario Universitario Of Albacete Chua | And 3 more authors.
Strahlentherapie und Onkologie | Year: 2013

Objective: The goal of this work was to evaluate whether the volume reduction related to removal of gas in the rectum could be translated in lower doses to organs at risk (OAR) during vaginal cuff brachytherapy (VBT). Material and methods: Fourteen pairs of brachytherapy planning CT scans derived from 11 patients were re-segmented and re-planned using the same parameters. The only difference between pairs of CTs was the presence or lack of gas in the rectum. The first CT showed the basal status and the second was carried out after gas removal with a tube. A set of values derived from bladder and rectum dose-volume histograms (DVH) and dose-surface histograms (DSH) were extracted. Moreover the cylinder position related to the patient craniocaudal axis was recorded. Results: Rectum volume decreased significantly from 77.8 ± 45 to 55.43 ± 17.6 ml (p = 0.0052) after gas removal. Such volume diminution represented a significant reduction on all rectal DVH parameters analyzed except D25 % and D50 %. DSH parameter results were similar to previous ones. A nonsignificant increase of the bladder volume was observed and was associated with an increase of the DVH metrics analyzed. Conclusion: Removal of gas pockets is a simple and inexpensive maneuver that decreases rectal dose parameters on VBT, which can be translated as a better therapeutic ratio. It also suggests that other actions directed to empty the rectum could have a similar effect. © 2013 Springer Heidelberg Berlin.

Sabater S.,Complejo Hospitalario Universitario Of Albacete Chua | Andres I.,Complejo Hospitalario Universitario Of Albacete Chua | Sevillano M.,Complejo Hospitalario Universitario Of Albacete Chua | Berenguer R.,Complejo Hospitalario Universitario Of Albacete Chua | And 2 more authors.
Brachytherapy | Year: 2014

Purpose: To compare dose summation using a single plan (SP) approach for vaginal cuff brachytherapy (VBT) against dose summation after a rigid or deformable registration for each VBT fraction, in women with early stage endometrial cancer receiving postoperative VBT. Methods and Materials: A retrospective analysis of 19 patients who received VBT as the sole adjuvant treatment was undertaken. For the purposes of the study, every VBT fraction was re-segmented and re-planned under the same conditions. CT-planning images were registered, initially following a rigid method and then using deformable registration. The transformation vectors were reused to warp the dose files, followed by the dose summation. Three dose accumulation scenarios were studied: (1) an SP approach, (2) a rigid dose warping summation (RDWS), (3) a deformable dose warping summation (DDWS). Each scenario was analyzed for 3 and 5 fractions to evaluate the effect of fractionation. D0.1cc, D1cc, D2cc, D5cc, D5%, and Dmean values were compared for organs at risk, such as the rectum and bladder. Results: No statistical significances were observed in rectal parameters between SP and RDWS or between SP and DDWS. Significant SP, RDWS and DDWS Dmean, D0.1cc, and D2cc metric differences for the 5 fractions bladder scenario were observed (p=0.0242, 0.0196, and 0.0242, respectively). Conclusions: A multi-image planning procedure for a VBT course leads to limited differences between different summation methods. SP is an effective and acceptable surrogate for absorbed doses in organs at risk. © 2014 American Brachytherapy Society.

Mira J.J.,University Miguel Hernández | Navarro I.M.,University Miguel Hernández | Guilabert M.,University Miguel Hernández | Aranaz J.,Hospital Universitari Sant Joan
Revista Panamericana de Salud Publica/Pan American Journal of Public Health | Year: 2012

Objective: Analyze the frequency of medication errors committed and reported by patients. Methods: Descriptive study based on a telephone survey of a random sample of adult patients from the primary care level of the Spanish public health care system. A total of 1 247 patients responded (75% response rate); 63% were women and 29% were older than 70 years. Results: While 37 patients (3%, 95% CI: 2-4) experienced complications associated with medication in the course of treatment, 241 (19.4%, 95% CI: 17-21) reported having made some mistake with their medication. A shorter consultation time (P < 0.01) and a worse assessment of the information provided by the physician (P < 0.01) were associated with the fact that during pharmacy dispensing the patient was told that the prescribed treatment was not appropriate. Conclusions: In addition to the known risks of an adverse event due to a health intervention resulting from a system or practitioner error, there are risks associated with patient errors in the self-administration of medication. Patients who were unsatisfied with the information provided by the physician reported a greater number of errors.

PubMed | Complejo Hospitalario Universitario Of Albacete Chua, University of Barcelona and Hospital Universitari Sant Joan
Type: Journal Article | Journal: Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] | Year: 2016

To evaluate the effects of rectal enemas on rectal doses during postoperative high-dose-rate (HDR) vaginal cuff brachytherapy (VCB).This prospective trial included 59patients. Two rectal cleansing enemas were self-administered before the second fraction, and fraction1 was considered the basal status. Dose-volume histogram (DVH) values were generated for the rectum and correlated with rectal volume variation. Statistical analyses used paired and unpaired t-tests.Despite a significant 15% reduction in mean rectal volume (44.07 vs. 52.15cc, p=0.0018), 35.6% of patients had larger rectums after rectal enemas. No significant rectal enema-related DVH differences were observed compared to the basal data. Although not statistically significant, rectal cleansing-associated increases in mean rectal DVH values were observed: D0.1cc: 6.6 vs. 7.21Gy; D1cc: 5.35 vs. 5.52Gy; D2cc: 4.67 vs. 4.72Gy, before and after rectal cleaning, respectively (where Dxcc is the dose to the most exposed xcm(3)). No differences were observed in DVH parameters according to rectal volume increase or decrease after the enema. Patients whose rectal volume increased also had significantly larger DVH parameters, except for D5%, D25%, and D50%. In contrast, in patients whose rectal volume decreased, significance was only seen for D25% and D50% (Dx% dose covering x% of the volume). In the latter patients, nonsignificant reductions in D2cc, D5cc and V5Gy (volume receiving at least 5Gy) were observed.The current rectal enemas protocol was ineffective in significantly modifying rectal DVH parameters for HDR-VCB.

PubMed | Hospital Universitari Sant Joan
Type: Journal Article | Journal: Medicina clinica | Year: 2016

Obesity is the main risk factor for obstructive sleep apnoea (OSA). The aim was to evaluate the long-term effect of continuous positive airway pressure (CPAP) on intraabdominal fat distribution in OSA patients.Fifty OSA patients with and 35 without CPAP treatment criteria were followed-up for 2 years. Visceral and subcutaneous adipose tissue (VAT and SAT) and preaortic intraabdominal fat (PIF) were assessed by sonography.In the non CPAP treated group, SAT and VAT mean values didnt change, while a significantly PIF growth was observed (55.19 [23.44] vs. 63.45 [23.94] mm, P=.021). In the CPAP treated group, VAT and PIF mean were not changed, while SAT decreased significantly (11.29 [5.69] vs. 10.47 [5.71] mm, P=.012).Long-term CPAP treatment produces intraabdominal fat redistribution and is associated with an anthropometric profile of lower cardiovascular risk in OSA patients.

PubMed | University of Castilla - La Mancha, Complejo Hospitalario Universitario Of Albacete Chua, Hospital Son Espases, University of Barcelona and Hospital Universitari Sant Joan
Type: Journal Article | Journal: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology | Year: 2016

Our aim was to analyse the feasibility of integrating an MRI acquired in a non-radiotherapy set-up into the prostate cancer radiotherapy workflow.The MRIs of 15 prostate cancer patients, acquired with a flat table-top (MRI-flat), and with a curved tabletop (MRI-curve) were analysed. MRIs were rigidly (RIR) and non-rigidly registered (DIR) with CT images. The prostate and rectum were contoured in each image set and translated to the CT, and IMRT plans were computed taking into account structural changes after RIR and DIR (P-flatRIR, P-curveRIR and P-curveDIR). In addition the P-curveDIR was overlaid with RIR structures. Spatial overlap parameters and dose-volume histogram metrics were generated.No significant differences were observed among P-flatRIR and P-curveRIR or P-flatRIR and P-curveDIR. Median gamma-values: P-curveRIR, 95.3%; P-curveDIR, 96%, translated-P-curveDIR, 95%. DVH metrics for translated-P-curveDIR were: Dmin, 64.5Gy; Dmean, 70.06Gy; V95%, 100%. No statistically significant differences were found in the dosimetric MRI-flatDIR values.The dosimetric reproduction of treatment position image following image registration of non-radiotherapy set-up images suggests that it is feasible to integrate these images into the radiotherapy workflow.

PubMed | Instituto Max Weber, Hospital Universitari Sant Joan and Hospital Universitario Lucus Augusti
Type: Journal Article | Journal: Archivos de bronconeumologia | Year: 2016

The socioeconomic impact of obstructive sleep apnea-hypopnea syndrome (OSAHS) is considerable. The aim of this study was to evaluate the cost-effectiveness of treating OSAHS with continuous positive airway pressure (CPAP) and the impact of CPAP compliance.This was a retrospective, case-crossover study of 373 patients with OSAHS receiving CPAP. We compared changes in costs, Epworth score and health-related quality of life (EQ-5D questionnaires) between the year before treatment and the year after treatment. The incremental cost-effectiveness ratio (ICER) for the first year of treatment was estimated, and projections were made for the second year, using different effectiveness and cost scenarios.The visual analog scale score for the EQ-5D questionnaire increased by 5 points and the Epworth score fell by 10 points during the year of CPAP treatment. Mean gain in quality-adjusted life years (QALY) was 0.05 per patient per year (P<.001): 0.07 among compliers and -0.04 among non-compliers. ICER was 51,147/QALY during the first year of CPAP treatment and 1,544/QALY during the second year.CPAP treatment in patients with moderate-severe OSAHS improves the quality of life of compliant patients, and is cost-effective as of the second year.

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