Objective In patients with iron deficiency anaemia (IDA), the diagnostic yield of gastroscopy and colonoscopy (bidirectional endoscopy) in detecting neoplastic lesions is low. This study aimed to ...develop and validate a faecal immunochemical test (FIT)-based model to optimise the work-up of patients with IDA. Methods Outpatients with IDA were enrolled in a prospective, multicentre study from April 2016 to October 2019. One FIT was performed before bidirectional endoscopy. Significant gastrointestinal lesions were recorded and a combined model developed with variables that were independently associated with significant colorectal lesions in the multivariate analysis. The model cut-off was selected to provide a sensitivity of at least 95% for colorectal cancer (CRC) detection, and its performance was compared to different FIT cut-offs. The data set was randomly split into two groups (developed and validation cohorts). An online calculator was developed for clinical application. Results The development and validation cohorts included 373 and 160 patients, respectively. The developed model included FIT value, age, and sex. In the development and validation cohorts, a model cut-off of 0.1375 provided a negative predictive value of 98.1 and 96.7% for CRC and 90.7 and 88.3% for significant colorectal lesions, respectively. This combined model reduced the rate of missed significant colorectal lesions compared to FIT alone and could have avoided more than one-fourth of colonoscopies. Conclusion The FIT-based combined model developed in this study may serve as a useful diagnostic tool to triage IDA patients for early endoscopic referral, resulting in considerable reduction of unnecessary colonoscopies.
Ultrasound (US) of major salivary glands (MSG) evaluates echogenicity, border features and vascularization, with elastography, it can detect tissue elasticity and glandular fibrosis, related to ...inflammation in Primary Sjögren’s syndrome (pSS). This study aimed to develop a novel technique by pixel analysis for evaluation and interpretation of elastography in MSG in pSS. A cross-sectional and observational multicenter study was conducted. The US of MSG performed in orthogonal planes in grayscale, Doppler, and shear-wave elastography. For elastography images of each gland were analyzed with the open-source program ImageJ to perform a pixel analysis. Statistical analysis was performed with the IBM-SPSS v25 program. Fifty-nine women with a mean age of 57.69 (23–83) years were recruited; pSS mean duration of 87 (5–275) months, and 12 healthy women without sicca symptoms as a control group with a mean age of 50.67 (42–60) years. Intragroup analysis showed
p
-values >0.05 between sicca symptoms, ocular/dryness tests, biopsy, US, and pixel analysis; correlation between Hocevar and pixel analysis was not found (rho < 0.1,
p
>0.5). MSG anatomical size was 41.7 ± 28.2 mm vs. 67.6 ± 8.8 mm (
p
≤ 0.0001); unstimulated whole saliva flow rate was 0.80 ± 0.80 ml/5 min vs. 1.85 ± 1.27 ml/5 min (
p
= 0.016). The elastography values (absolute number of pixels) were 572.38 ± 99.21 vs. 539.69 ± 93.12 (
p
= 0.290). A cut-off point risk for pSS identified with less than 54% of red pixels in the global MSG mass OR of 3.8 95% CI (1.01–15.00). Pixel analysis is a new tool that could lead to a better understanding of the MSG chronic inflammatory process in pSS.
Recent decades have seen a growing acknowledgement of violence against women (VAW) as a serious social and public health problem of epidemic proportions. The prevention of VAW and intimate partner ...violence against women (IPVAW) has become a priority within this context, and includes various prevention strategies such as social participation and helping behaviors. In different countries, conducting research on help-seeking behavior and bystander intervention in cases of VAW is a common practice, but addressing these issues is much less common in Spain. In this context, the objective of this study is to provide a preliminary estimation of the volume of bystanders in cases of IPVAW in Spain between 2005 and 2020 (since the entry into force of Organic Law 1/2004), their willingness to intervene and, in the case of intervention, the type of helping behavior (real or hypothetical) preferred, using the sources (secondary data) available (specifically, survey data, as the surveys of social perception of gender violence and the 2014 and 2019 macro-surveys, and also administrative data, as the database of reports filed). The data analyzed allow us to determine that, in fact, in the cases of IPVAW there are usually persons within the victim’s inner circle who are firsthand witnesses or have been informed by the victim of the existence of this type of violence, but, although the bystanders generally claim they would engage in an active and supportive response, this is in fact not always the case. These results underscore the need to develop intervention programs aimed at IPVAW bystanders to improve their reaction and contribute to the development of helpful and efficient active responses.
Background
The Movement Disorder Society‐sponsored Non‐motor Rating Scale (MDS‐NMS) assess the severity and disability caused by non‐motor symptoms (NMS) in Parkinson's disease (PD).
Objective
This ...article encapsulates the formal process for completing this program and the data on the first officially approved non‐English version of the MDS‐NMS (Spanish).
Methods
The MDS‐NMS translation program involves four steps: translation and back‐translation; cognitive pre‐testing to ensure that raters and patients understand the scale and are comfortable with its content; field testing of the finalized version; analysis of the factor structure of the tested version against the original English language version for the nine domains that could be analyzed in a confirmatory factor analysis. To be designated an “Official MDS translation,” the confirmatory factor analysis Comparative Fit Index had to be ≥0.90.
Results
The Spanish MDS‐NMS was tested in 364 native‐Spanish‐speaking patients with PD from seven countries. For all subjects with fully computable data with all domains of the MDS‐NMS (n = 349), the Comparative Fit Index was ≥0.90 for the nine eligible domains. Missing data were negligible and moderate floor effect (42.90%) was found for the Non‐Motor Fluctuations subscale. Item homogeneity coefficient was adequate, and the correlation of the MDS‐NMS domains with other measures for related constructs was acceptable (rs ≥ 0.50).
Conclusions
The Spanish version of the MDS‐NMS followed the IPMDS Translation Program protocol, reached the criterion to be designated as an Official Translation, and is now available on the MDS website.
BackgroundThe therapeutic landscape for spinal muscular atrophy has changed in the last few years, encompassing respiratory/motor function and life expectancy benefits. However, physicians still have ...the challenge of tailoring individuals' treatment to therapeutic goals, disease progression, patient/caregiver's preferences, and personal experience to achieve an optimal risk/benefit balance. This study aims to provide insight into the preferred treatment choices of pediatric neurologists managing spinal muscular atrophy in their daily practice and to recognize behavioral factors that may influence decision-making.MethodsThis is a noninterventional, cross-sectional pilot study involving 50 pediatric neurologists managing spinal muscular atrophy in Spain. We designed an online platform that contains 13 simulated case scenarios of common presentations of patients with spinal muscular atrophy. The primary study outcome will be treatment preferences according to the percentages of participants who select treatment initiation when recommended, switch therapies when there is evidence of disease progression, and select treatment discontinuation when disease progression puts patients outside treatment recommendation (11 case scenarios). Secondary outcomes include therapeutic inertia prevalence (11 case scenarios), herding phenomenon prevalence (2 case scenarios), care-related regret prevalence (specific questions) and intensity (10-item Regret Intensity Scale), occupational burnout prevalence (nonproprietary single-item measure), and risk preferences (uncertainty test and risk aversion assessment).ConclusionsThe study findings will contribute to better understand relevant factors associated with therapeutic decisions of pediatric neurologists in spinal muscular atrophy, identifying treatment preferences and evaluating the role of behavioral aspects such as therapeutic inertia, herding, regret, and workplace burnout.
IntroductionIn recent years, multiple studies have aimed to develop and validate portable technological devices capable of monitoring the motor complications of Parkinson’s disease patients ...(Parkinson’s Holter). The effectiveness of these monitoring devices for improving clinical control is not known.Methods and analysisThis is a single-blind, cluster-randomised controlled clinical trial. Neurologists from Spanish health centres will be randomly assigned to one of three study arms (1:1:1): (a) therapeutic adjustment using information from a Parkinson’s Holter that will be worn by their patients for 7 days, (b) therapeutic adjustment using information from a diary of motor fluctuations that will be completed by their patients for 7 days and (c) therapeutic adjustment using clinical information collected during consultation. It is expected that 162 consecutive patients will be included over a period of 6 months.The primary outcome is the efficiency of the Parkinson’s Holter compared with traditional clinical practice in terms of Off time reduction with respect to the baseline (recorded through a diary of motor fluctuations, which will be completed by all patients). As secondary outcomes, changes in variables related to other motor complications (dyskinesia and freezing of gait), quality of life, autonomy in activities of daily living, adherence to the monitoring system and number of doctor–patient contacts will be analysed. The noninferiority of the Parkinson’s Holter against the diary of motor fluctuations in terms of Off time reduction will be studied as the exploratory objective.Ethics and dissemination approval for this study has been obtained from the Hospital Universitari de Bellvitge Ethics Committee. The results of this study will inform the practical utility of the objective information provided by a Parkinson’s Holter and, therefore, the convenience of adopting this technology in clinical practice and in future clinical trials. We expect public dissemination of the results in 2022.Trial registrationNCT04176302; https://clinicaltrials.gov/show/NCT04176302
Chronic kidney disease (CKD) requires patients to participate in an adaptation process, which may be facilitated with the support of healthcare professionals and trained peers. The objective of this ...study is to present the implementation of a pilot patient mentoring programme to promote adaptation in patients with CKD.
Pre-test-post-test design (quantitative and qualitative). The study was carried out in six hospitals in Spain. The instruments used to measure impact were ad-hoc scales (10-point Likert scale response format) on satisfaction and skill acquisition, as well as the creation of focus groups with eight patient mentors and 10 healthcare professionals. The programme was split into four phases: 1. Design and validation of the manualised programme's content, and selection of patient mentors; 2. Mentor training, satisfaction with training and skills acquired by the mentors; 3. Implementation of mutual support groups and profile of those attending these mutual support groups; 4. Assessment and results of the Mentoring programme.
In total, 39 mentors were trained on group management skills, as well as how to provide emotional support. 22 support groups were held, with 121 participants (22% carers). The 65% of the patients were attending the CKD clinic. 65% of the participating patients considered making some form of lifestyle change after taking part in the programme. All the items assessing satisfaction and usefulness scored very highly, achieving 8.5 out of 10 or above.
This is the first manualised mentoring programme in CKD to be undertaken simultaneously in six Spanish hospitals. The manualised and highly structured nature of the programme make it easy to replicate, minimising the risk of error.
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