Hospital Universitario Nuestra Senora Of Valme

Sevilla, Spain

Hospital Universitario Nuestra Senora Of Valme

Sevilla, Spain
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PubMed | Complejo Hospitalario Regional Virgen Macarena, Hospital Of Mataro, Hospital Universitario Marques Of Valdecilla, Hospital Universitario Nuestra Senora Of Valme and 12 more.
Type: | Journal: Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico | Year: 2016

The Spanish Society of Medical Oncology (SEOM) has conducted a study on the access to oncologic drugs across the 17 Spanish Regions with the aim of identifying potential heterogeneities and making proposals for eliminating the barriers identified at the different levels.An Expert Panel made up of medical oncologists designed a survey on certain indications approved for 11 drugs in the approach of breast cancer, melanoma, lung cancer, prostate cancer and support treatment. This survey was sent to 144 National Health System (NHS) hospitals.77 hospitals answered the survey. The information modules analysed were: scope of the Commission that establishes binding decisions related to drug access; conditions, stages and periods of drug application, approval and administration processes; barriers to accessing drugs.The study shows variability in drug access. The SEOM makes proposals addressed to reducing the differences identified and homogenizing drug access conditions.


PubMed | Hospital Universitario La Paz, Complejo Hospitalario Of Jaen, Hospital Universitario 12 Of Octubre, Hospital Universitario Central Of Asturias and 16 more.
Type: | Journal: Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico | Year: 2016

Metastatic breast cancer is a heterogeneous disease that presents in varying forms, and a growing number of therapeutic options makes it difficult to determine the best choice in each particular situation. When selecting a systemic treatment, it is important to consider the medication administered in the previous stages, such as acquired resistance, type of progression, time to relapse, tumor aggressiveness, age, comorbidities, pre- and post-menopausal status, and patient preferences. Moreover, tumor genomic signatures can identify different subtypes, which can be used to create patient profiles and design specific therapies. However, there is no consensus regarding the best treatment sequence for each subgroup of patients. During the SABCC Congress of 2014, specialized breast cancer oncologists from referral hospitals in Europe met to define patient profiles and to determine specific treatment sequences for each one. Conclusions were then debated in a final meeting in which a relative degree of consensus for each treatment sequence was established. Four patient profiles were defined according to established breast cancer phenotypes: pre-menopausal patients with luminal subtype, post-menopausal patients with luminal subtype, patients with triple-negative subtype, and patients with HER2-positive subtype. A treatment sequence was then defined, consisting of hormonal therapy with tamoxifen, aromatase inhibitors, fulvestrant, and mTOR inhibitors for pre- and post-menopausal patien ts; a chemotherapy sequence for the first, second, and further lines for luminal and triple-negative patients; and an optimal sequence for treatment with new antiHER2 therapies. Finally, a document detailing all treatment sequences, that had the agreement of all the oncologists, was drawn up as a guideline and advocacy tool for professionals treating patients with this disease.


PubMed | Hospital Universitario Nuestra Senora Of Valme, Organizacion Sanitaria Integrada Bilbao Basurto, Hospital Clinico San Carlos, University of Santiago de Compostela and 3 more.
Type: | Journal: Patient preference and adherence | Year: 2016

Home enteral nutrition (HEN) is indicated in patients with a functional gastrointestinal tract but who are unable to meet their nutritional requirements with normally consumed foodstuffs. HEN allows patients to remain in their social and family environment, thus reducing complications and costs associated with hospital admission, while increasing health-related quality of life (HRQoL). HRQoL in patients with HEN is mainly evaluated by generic instruments, which are not sensitive enough to identify certain specific patient-related outcomes of HEN.To develop a specific instrument to measure HRQoL in patients receiving HEN whose results allow interpretation regardless of the underlying disease and nutritional support administration route: the NutriQoLThe development of the NutriQoL entailed a literature review, focus groups with experts, semistructured interviews with patients, an assessment of face validity and feasibility, and Rasch analysis conducted on data from a sample of 141 patients and 24 caregivers.Of the 52 items initially proposed on the basis of the literature review, expert focus group, and semi-structured interviews with patients and caregivers, 17 items were finally selected through the development process to make up the final version of the NutriQoL, as well as a visual analog scale for global HRQoL scoring. The selected items were evaluated as adequate for frequency, importance, and clarity. Furthermore, they have been shown to be independent of the underlying condition and HEN administration route.A new instrument for measuring the HRQoL of patients with HEN in Spain has been developed, whose results are independent of the underlying condition and administration route. The next step will be the validation of the questionnaire to ensure that the instrument is valid, reliable, and sensitive to health status changes in patients, to be used periodically in usual clinical practice.


Afdhal N.,Beth Israel Deaconess Medical Center | Zeuzem S.,Goethe University Frankfurt | Kwo P.,Indiana University | Chojkier M.,University of California at San Diego | And 20 more authors.
New England Journal of Medicine | Year: 2014

BACKGROUND: In phase 2 studies, treatment with the all-oral combination of the nucleotide polymerase inhibitor sofosbuvir and the NS5A inhibitor ledipasvir resulted in high rates of sustained virologic response among previously untreated patients with hepatitis C virus (HCV) genotype 1 infection. METHODS: We conducted a phase 3, open-label study involving previously untreated patients with chronic HCV genotype 1 infection. Patients were randomly assigned in a 1:1:1:1 ratio to receive ledipasvir and sofosbuvir in a fixed-dose combination tablet once daily for 12 weeks, ledipasvir-sofosbuvir plus ribavirin for 12 weeks, ledipasvir-sofosbuvir for 24 weeks, or ledipasvir-sofosbuvir plus ribavirin for 24 weeks. The primary end point was a sustained virologic response at 12 weeks after the end of therapy. RESULTS: Of the 865 patients who underwent randomization and were treated, 16% had cirrhosis, 12% were black, and 67% had HCV genotype 1a infection. The rates of sustained virologic response were 99% (95% confidence interval [CI], 96 to 100) in the group that received 12 weeks of ledipasvir-sofosbuvir; 97% (95% CI, 94 to 99) in the group that received 12 weeks of ledipasvir-sofosbuvir plus ribavirin; 98% (95% CI, 95 to 99) in the group that received 24 weeks of ledipasvir-sofosbuvir; and 99% (95% CI, 97 to 100) in the group that received 24 weeks of ledipasvir-sofosbuvir plus ribavirin. No patient in either 12-week group discontinued ledipasvir- sofosbuvir owing to an adverse event. The most common adverse events were fatigue, headache, insomnia, and nausea. CONCLUSIONS: Once-daily ledipasvir-sofosbuvir with or without ribavirin for 12 or 24 weeks was highly effective in previously untreated patients with HCV genotype 1 infection. (Funded by Gilead Sciences; ION-1 ClinicalTrials.gov number NCT01701401.) Copyright © 2014 Massachusetts Medical Society.


PubMed | Complejo Hospitalario Universitario Of Cartagena, Hospital Universitario Nuestra Senora Of Valme, Hospital Moncloa, Hospital General Of Castello and 4 more.
Type: Journal Article | Journal: Medicina intensiva | Year: 2016

To evaluate the use and effectiveness of a routine invasive strategy (RIS) in patients with acute coronary syndrome without persistent ST-segment elevation with renal dysfunction in the real world scenario.A retrospective cohort study based on the ARIAM-SEMICYUC Registry (2011-2014) was carried out. Renal dysfunction was defined as GFR (Cockroft-Gault)<60ml/min (moderate dysfunction) or<30ml/min (severe dysfunction). Patients in which early angiography (<72h) was performed due to cardiogenic shock or recurrent myocardial ischemia were excluded. The primary endpoint was hospital mortality. Confounding factors were controlled using propensity score analysis.A total of 4,279 patients were analyzed, of which 26% had moderate renal dysfunction and 5% severe dysfunction. Patients with renal dysfunction had greater severity and comorbidity, higher hospital mortality (8.6 vs. 1.8%), and lesser use of the RIS (40 vs. 52%). The adjusted OR for mortality in patients without/with renal dysfunction were 0.38 (95% confidence interval [95%CI] 0.17 to 0.81) and 0.52 (95%CI 0.32 to 0.87), respectively (interaction P-value=.4779). The impact (adjusted risk difference) of RIS was higher in the group with renal dysfunction (-5.1%, 95%CI -8.1 to -2.1 vs. -1.6%, 95%CI -2.6 to -0.6; interaction P-value=.0335). No significant interaction was detected for the other endpoints considered (ICU mortality, 30-day mortality, myocardial infarction, acute renal failure or moderate/severe bleeding).The results suggest that the effectiveness of IRS is similar in patients with normal or abnormal renal function, and alert to the under-utilization of this strategy in such patients.


Tocino A.,IVI Seville | Blasco V.,IVI Seville | Prados N.,IVI Seville | Prados N.,Pablo De Olavide University | And 6 more authors.
Fertility and Sterility | Year: 2015

Objective To describe a case of monozygotic twinning with asymmetric development following a single fresh embryo transfer as part of an intracytoplasmic sperm injection (ICSI) treatment. Secondarily, to report the incidence of monozygotic twinning at the IVI (Instituto Valenciano de Infertilidad) clinics. Design Case report. Setting Private fertility centers. Patient(s) A 33-year-old woman with a 2-year history of primary infertility. Intervention(s) Controlled ovarian hyperstimulation and ICSI treatment with single-embryo transfer. Main Outcome Measure(s) Incidence of monozygotic twinning at the IVI clinics. Result(s) We report a twin pregnancy after a single-embryo transfer. Twins were dichorionic and diamniotic. One fetus had a 6-day delay in its growth compared with the other when observed by ultrasound. Two female infants were delivered, and despite presenting congenital diseases, they were successfully treated and evolved correctly. A subsequent DNA analysis confirmed that the infants were monozygotic. Furthermore, we estimated a monozygotic twinning rate of 1.17% at the IVI clinics, taking into account those cases in which two or more embryos with heart beats were observed by ultrasound scanning after single-embryo transfers. Conclusion(s) Ultrasound scans performed during pregnancy suggested a possible dizygotic origin of the twins, but DNA analysis performed after birth established that they were monozygotic. Genetic analysis is the only valid tool to confirm if like-sex dichorionic twins are monozygotic or dizygotic. © 2015 American Society for Reproductive Medicine.


Tunez I.,University of Cordoba, Spain | Sanchez-Lopez F.,Hospital Universitario Reina Sofia Of Cordoba | Aguera E.,Hospital Universitario Reina Sofia Of Cordoba | Fernandez-Bolanos R.,Hospital Universitario Nuestra Senora Of Valme | And 2 more authors.
Journal of Medicinal Chemistry | Year: 2011

This study examined global oxidative stress (GOS) and antioxidant system and their correlation with disease stage in 19 patients with HD. The results revealed an increase in oxidative stress biomarkers and a reduction in antioxidant systems in HD patients. The effects were more intense in HD1 than in HD2 patients. Additionally, carbonylated proteins and GOS were correlated with disease stage. These findings suggest that oxidative stress plays an important role in the pathogenesis of HD. © 2011 American Chemical Society.


Espino R.,Hospital Universitario Nuestra Senora Of Valme
Anales de Pediatria | Year: 2012

An epidemiological study was conducted to assess the anthropometric development in children diagnosed with primary monosymptomatic nocturnal enuresis, depending on the treatment option selected. Patients and methods: A longitudinal series of cases including 548 children aged 5-10 years. Anthropometric parameters of children were assessed at diagnosis, and after one and two years of treatment. Results: Children with primary monosymptomatic nocturnal enuresis showed no anthropometric changes when their data were compared to the standard deviation score of height, weight, and body mass index (BMI). Overall, no changes were seen in the above mentioned parameters after two years of treatment for enuresis (except for a weight standard deviation score (SDS) decrease in boys). We only found a decrease in the size and weight in those children undergoing behavioral therapy with or without an alarm, findings that, given the limitations of the study, were not considered significant. The odds ratio for cure after one and two years of treatment was 1.41 (95% CI: 0.85-2.34) and 1.52 (95% CI: 0.86-2.70) for desmopressin (and watchful waiting) as compared to all other options. Conclusions: In this study, children had SDS values of height, weight, and BMI similar to healthy children of the same age and sex before and after treatment for primary monosymptomatic nocturnal enuresis. Desmopressin appeared to increase the probability of cure after one and two years of treatment, however these data should be corroborated in future randomized clinical trials. © 2011 Asociación Española de Pediatría.


Socias Crespi L.,Hospital Son Llatzer | Ceniceros Rozalen M.I.,Servicio de Emergencias del 061 Illes Balears | Rubio Roca P.,Servicio de Emergencias del 061 Illes Balears | Martinez Cuellar N.,Servicio de Emergencias del 061 Illes Balears | And 3 more authors.
Medicina Intensiva | Year: 2015

Objective: To describe the epidemiology of out-of-hospital cardiorespiratory arrest (OHCA) and identify factors associated with recovery of spontaneous circulation (ROSC). Design: Observational study of OHCA registered on a continuous basis in the Emergency Medical Services (EMS) database during 2009-2012. Setting: The islands of Mallorca, Ibiza, Menorca and Formentera (Balearic Islands, Spain). Patients: OHCA in patients ≥ 18 years of age.The main variables were: Patient sex, age, probable cause, place of arrest, bystander, witnessed, basic life support (BLS), shockable rhythm, intervention time, semi-automatic defibrillator (AED), duration of cardiopulmonary arrest (CA), and ROSC. Independent variables were defined according to the Utstein protocol, and the dependent variable was defined as ROSC. Results: The EMS treated 1170 OHCAs (28/100,000 persons-year). We included 1130 CA. The mean age was 61.4 years (73.4% males). Most CA (72.3%) were of cardiac etiology, and 84.7% were witnessed. A total of 840 (74.3%) received BLS and 400 (47.6%) did so before arrival of the EMS (45 by bystander relatives). AED was available in 330 cases CA (29.2%) (96 with shockable rhythm). The interval between emergency call and BLS and between emergency call and advanced life support was 8.4 and 15.8. min, respectively. Shockable rhythm was monitored in 257 CAs (22.7%). ROSC occurred in 261 (23.1%). Factors associated with ROSC were age, shockable rhythm, BLS before EMS arrival, and CA duration less than 30. min. Conclusion: The incidence rate of the OHCA is low. The proportion of patients receiving BLS from relatives was low. Age, shockable rhythm and BSL before EMS arrival were associated with ROSC. © 2013 Elsevier España, S.L.U. and SEMICYUC.


Navarro Valverde C.,Hospital Universitario Nuestra Senora Of Valme | Nunez Gil I.,Hospital Clinico San Carlos | Fernandez Ortiz A.,Hospital Clinico San Carlos
Medicina Clinica | Year: 2013

Obstructive coronary artery disease is not detected in up to 14% of patients who present with acute coronary syndrome (ACS). Diagnosis of the underlying cause is usually not made and there is much controversy regarding prognosis. Those patients who develop ACS while having normal or near normal coronary arteries are more frequently young women and have fewer cardiovascular risk factors (CVRF). Its prognosis has typically been excellent. However, different results published in recent years show that these conditions are not always so benign. This might be explained by the different degrees of coronary obstruction, varied clinical presentation, biomarkers' mobilization or CVRF. It is necessary to determine the cause of ACS and stratify the risk of these patients in order to establish the appropriate treatment. This is especially relevant in those cases of coronary disease not detected by angiography, in which the absence of specific treatment can lead to poorer prognosis. © 2012 Elsevier España, S.L. All rights reserved.

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