The Monitoring Studies (MS) program, the approach developed by RedETS to generate postlaunch real-world evidence (RWE), is intended to complement and enhance the conventional health technology ...assessment process to support health policy decision making in Spain, besides informing other interested stakeholders, including clinicians and patients. The MS program is focused on specific uncertainties about the real effect, safety, costs, and routine use of new and insufficiently assessed relevant medical devices carefully selected to ensure the value of the additional research needed, by means of structured, controlled, participative, and transparent procedures. However, despite a clear political commitment and economic support from national and regional health authorities, several difficulties were identified along the development and implementation of the first wave of MS, delaying its execution and final reporting. Resolution of these difficulties at the regional and national levels and a greater collaborative impulse in the European Union, given the availability of an appropriate methodological framework already provided by EUnetHTA, might provide a faster and more efficient comparative RWE of improved quality and reliability at the national and international levels.
Resumen Objetivo Conocer la capacidad de la resonancia magnética nuclear mamaria preoperatoria para valorar su influencia en el tratamiento final del cáncer de mama Material y métodos Incluimos a las ...pacientes diagnosticadas de carcinoma de mama infiltrante o carcinoma ductal in situ en el Hospital Nuestra Señora de Gracia de Zaragoza entre enero de 2010 y diciembre de 2013. Todas ellas tenían estudios con mamografía o ecografía y fueron operadas en el mismo centro del diagnóstico con el estudio anatomopatológico final como «prueba de oro». Resultados En un 40% de las pacientes, la resonancia provocó un cambio del tratamiento final. En un 8% de las pacientes el cambio fue no relevante, ya que se aumentó el margen de la cirugía conservadora en 1 cm como máximo. En el 32% del total de pacientes, en las que sí que consideramos que la resonancia influyó de una manera significativa en la modificación del tratamiento, el cambio más frecuentemente realizado fue de cirugía conservadora a mastectomía. Conclusiones La resonancia nuclear magnética mamaria determina de una forma más correcta el tratamiento final del cáncer de mama con una tasa de 4,45% de falsos positivos.
Information on experience/management of severe hypoglycaemic events (SHEs) among people with insulin-treated diabetes (PWD) and caregivers (CGs) providing care to PWD was sought.
An online ...cross-sectional survey was conducted in eight countries. Inclusion criteria: PWD (aged≥18 years; self-reported type 1 T1D or insulin-treated type 2 T2D diabetes; experienced ≥1 SHE hypoglycaemia requiring external assistance in past 3 years); CGs (layperson aged ≥18 years; caring for PWD meeting all criteria above except age ≥4 years). This descriptive analysis provides data from Spain. SHE-associated data relate to the most recent SHE.
Across all groups (T1D PWD, n=106; T2D PWD, n=88, T1D CG, n=87; T2D CG, n=96), 76–89% reported that the SHE occurred at home; most common cause was eating less than planned (38–53%). Most usual action during the SHE was to intake carbohydrates (67–84%); glucagon use was low (9–36%). Discussion of the SHE with their healthcare provider (HCP) was reported by 70–75% of PWD. During the SHE, 35–69% of PWD/CGs reported feeling scared, unprepared and/or helpless.
Most SHEs occurred outside the healthcare setting; treatment therefore depends greatly on CGs. SHEs have a negative emotional impact on PWD/CGs, underscoring the need for HCPs to discuss SHEs with PWD/CGs, and to provide tools and strategies to prevent and effectively manage SHEs.
Se recopiló información sobre la experiencia y el manejo de episodios de hipoglucemia grave (EHG) entre personas con diabetes (PCD) tratadas con insulina y sus cuidadores.
Se realizó una encuesta transversal online en ocho países. Criterios de inclusión: PCD de ≥18 años con diabetes tipo 1 (DT1) o diabetes tipo 2 (DT2) tratada con insulina autoinformada y ≥ 1 EHG en los últimos tres años, que requirió asistencia externa; cuidador no profesional de ≥ 18 años que proporciona atención a PCD que cumplen los criterios anteriores excepto la edad (≥ cuatro años). Este análisis descriptivo proporciona información de España. Los datos de EHG se refieren al episodio más reciente.
En todos los grupos (PCD DT1, n = 106; PCD DT2, n = 88; cuidador DT1, n = 87; cuidador DT2, n = 96), un 76 a 89% refirió que el EHG ocurrió en casa; la causa más común fue comer menos de lo planeado (38 a 53%). La acción más habitual durante el EHG fue ingerir carbohidratos (67 a 84%); en pocos casos se usó glucagón (9 a 36%). El 70 a 75% de las PCD comentó el EHG con su profesional sanitario. Un 35 a 69% de las PCD/cuidadores refirieron que se sintieron asustadas, no preparadas y/o indefensas durante el EHG.
La mayoría de los EHG no ocurrieron dentro del sistema sanitario y, por tanto, el tratamiento depende fundamentalmente de los cuidadores. Los EHG tienen un impacto emocional negativo en las PCD y en los cuidadores, destacando la necesidad de que los profesionales sanitarios hablen con ellos sobre este tema y de proporcionar herramientas y estrategias para prevenir y controlar eficazmente los EHG.
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Researchers have analysed whether school and local knowledge complement or substitute each other, but have paid less attention to whether those two learning models use different cognitive strategies. ...In this study, we use data collected among three contemporary hunter-gatherer societies with relatively low levels of exposure to schooling yet with high levels of local ecological knowledge to test the association between i) schooling and ii) local ecological knowledge and verbal working memory. Participants include 94 people (24 Baka, 25 Punan, and 45 Tsimane') from whom we collected information on 1) schooling and school related skills (i.e., literacy and numeracy), 2) local knowledge and skills related to hunting and medicinal plants, and 3) working memory. To assess working memory, we applied a multi-trial free recall using words relevant to each cultural setting. People with and without schooling have similar levels of accurate and inaccurate recall, although they differ in their strategies to organize recall: people with schooling have higher results for serial clustering, suggesting better learning with repetition, whereas people without schooling have higher results for semantic clustering, suggesting they organize recall around semantically meaningful categories. Individual levels of local ecological knowledge are not related to accurate recall or organization recall, arguably due to overall high levels of local ecological knowledge. While schooling seems to favour some organization strategies this might come at the expense of some other organization strategies.
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Resumen La mastopatía diabética es una complicación poco frecuente y poco conocida de la diabetes mellitus, que puede simular un cáncer de mama. La forma más frecuente de presentación es un nódulo ...indoloro de consistencia pétrea y de márgenes irregulares. Los resultados de las pruebas diagnósticas de imagen son inespecíficos, siendo imprescindible para su diagnóstico el estudio anatomopatológico que pondrá de manifiesto fibrosis estromal asociada a ductitis, lobulitis y vasculitis linfocítica. Presentamos el caso de una paciente diabética tipo 1 de 33 años de evolución que consultó por un nódulo en la mama, el cual fue sometido a estudio mamográfico y ecográfico, con diagnóstico de lesión sospechosa de malignidad (BIRADS IV ). Se realizó una biopsia con aguja gruesa y el resultado anatomopatológico fue compatible con mastopatía diabética.
Research on natural resource management suggests that local perceptions form the basis upon which many small-scale societies monitor availability and change in the stock of common-pool natural ...resources. With empirical evidence on this matter still highly limited, we explored the role of local perceptions as drivers of harvesting and management behavior in a small-scale society in Bolivian Amazonia. We analyzed whether perceptions of availability match estimates of abundance obtained from ecological data and whether differences in perception help to explain harvesting behavior and local management of thatch palm. Our findings show that most of the harvesting and management actions that the Tsimane' undertake are, at least partially, shaped by their local perceptions. This paper contributes to the broader literature on natural resource management by providing empirical evidence of the critical role of local perceptions in promoting collective responses for the sustainable management of natural resources.
The implantable cardioverter-defibrillator (ICD) is a well-recognized means of providing effective treatment for patients with ventricular tachycardia (VT) and structural heart disease. However, the ...benefits of these devices in patients with limited life-expectancy have been questioned. Moreover, the long-term efficacy of catheter ablation of VT in this setting is unknown.
This study involved 33 consecutive patients aged over 75 years with structural heart disease who underwent catheter ablation of VT. We investigated the efficacy of the procedure and its complications, and evaluated patient outcomes during follow-up.
The patients' mean age at the time of the procedure was 79.7 (3.7) years. Twenty-seven had ischemic heart disease and 6 had dilated cardiomyopathy. Their mean left ventricular ejection fraction (LVEF) was 35.9 (8.9%). Ablation of clinical VT was successful in 28 patients (84.8%). There were no statistically significant differences in the efficacy of ablation between patients with post-infarction scars (88.9%) and those with dilated cardiomyopathy (66.7%; P=.17). An ICD was implanted after the procedure in 4 patients. Complications associated with the procedure occurred in only 3 patients. Twenty patients were contacted later, after a mean follow-up period of 38.5 (27.7) months. Nine (mean age, 82.2 4.6 years) were still alive and reported a good quality of life, without recurrent arrhythmias.
Catheter ablation of VT in elderly patients with structural heart disease appeared to be effective and relatively safe. It could provide an alternative to ICD implantation in this patient group.
The implantable cardioverter-defibrillator (ICD) is a well-recognized means of providing effective treatment for patients with ventricular tachycardia (VT) and structural heart disease. However, the ...benefits of these devices in patients with limited life-expectancy have been questioned. Moreover, the long-term efficacy of catheter ablation of VT in this setting is unknown.
This study involved 33 consecutive patients aged over 75 years with structural heart disease who underwent catheter ablation of VT. We investigated the efficacy of the procedure and its complications, and evaluated patient outcomes during follow-up.
The patients’ mean age at the time of the procedure was 79.7 (3.7) years. Twenty-seven had ischemic heart disease and 6 had dilated cardiomyopathy. Their mean left ventricular ejection fraction (LVEF) was 35.9 (8.9%). Ablation of clinical VT was successful in 28 patients (84.8%). There were no statistically significant differences in the efficacy of ablation between patients with post-infarction scars (88.9%) and those with dilated cardiomyopathy (66.7%; P=.17). An ICD was implanted after the procedure in 4 patients. Complications associated with the procedure occurred in only 3 patients. Twenty patients were contacted later, after a mean follow-up period of 38.5 (27.7) months. Nine (mean age, 82.2 4.6 years) were still alive and reported a good quality of life, without recurrent arrhythmias.
Catheter ablation of VT in elderly patients with structural heart disease appeared to be effective and relatively safe. It could provide an alternative to ICD implantation in this patient group.
El desfibrilador automático implantable (DAI) es una terapia aceptada para pacientes con taquicardia ventricular (TV) y cardiopatía estructural, pero se cuestiona su beneficio en pacientes con expectativa de vida limitada. Asimismo, se desconoce la eficacia de la ablación con catéter a largo plazo en este contexto.
Se incluyó en el estudio a 33 pacientes consecutivos de edad > 75 años sometidos a ablación con catéter de una TV sobre cardiopatía estructural. Se analizaron la eficacia y las complicaciones del procedimiento, así como la evolución de los pacientes en el seguimiento.
La media de edad en el momento del procedimiento fue de 79,7
±
3,7 años; 27 pacientes tenían cardiopatía isquémica (CI) y 6, miocardiopatía dilatada (MCD). La fracción de eyección del ventrículo izquierdo (FEVI) fue 35,9%
±
8,9%. Se logró realizar la ablación con éxito de la TV clínica en 28 pacientes (84,8%). No se encontraron diferencias en la eficacia de la ablación entre los pacientes con cicatriz postinfarto (88,9%) y aquellos con MCD (66,7%) (p
=
0,17). Se implantó un DAI tras el procedimiento a 4 pacientes. Únicamente se produjeron complicaciones relacionadas con la ablación en 3 pacientes. Se logró contactar con 20 pacientes, con un seguimiento medio de 38,5
±
27,7 meses; 9 pacientes sobreviven en la actualidad (media de edad, 82,2
±
4,6 años) y refieren una buena calidad de vida, sin recurrencias arrítmicas.
La ablación de TV en pacientes ancianos con cardiopatía estructural parece eficaz y relativamente segura, y podría constituir una alternativa al DAI en esta población seleccionada
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