Antiplatelet pretreatment in patients with non-ST elevation acute coronary syndrome (NSTE-ACS) is controversial. It is vital that the risk of ischaemia and the risk of haemorrhage are both considered when managing this patient group. Current clinical guidelines do not recommend routine pretreatment in patients presenting with NSTE-ACS who are having coronary angiography within 24 hours. However, a significant portion of these patients will not have coronary angiography until after 24 hours. Pretreatment with antiplatelets may reduce the risk of ischaemic events, but it is associated with bleeding and delays to coronary artery bypass grafting, and it may be deleterious in patients with diagnoses other than NSTE-ACS, such as acute aortic syndromes, pulmonary embolism or intracranial bleeds. This review analyses the most important studies assessing antiplatelet pretreatment in NSTE-ACS.
BACKGROUND:The lack of standardised protocols for the pathological assessment of pancreatic resection specimens in pancreatic ductal adenocarcinoma results in substantial variability in diagnostic practice, with relevant clinical and organisational implications. OBJECTIVE:To present a position statement of the Societat Catalana de Pàncrees (SCPanc) and the Societat Catalana d'Anatomia Patològica (SCAP) on the pathological assessment of pancreatic resection specimens in exocrine pancreatic cancer. METHODS:Both scientific societies appointed a panel of experts in pancreatic pathology. The document was developed through a narrative literature review, iterative expert meetings and consensus-based definition of practical clinical scenarios. CONTENT:Specimen reception and fixation; grossing protocol; margin sampling (including vascular resections); staging (TNM) and treatment response; reporting templates; practical appendices. CONCLUSIONS:This position statement provides an original, practice-oriented and consensus-based framework for the pathological assessment of pancreatic resections, aiming to harmonise reporting and support high-quality routine diagnostic practice.
Background : Gastrectomy with D2 lymphadenectomy is the key curative treatment for nonmetastatic advanced gastric cancer. Omentectomy has traditionally been considered an essential component of surgery for the theoretical removal of micrometastases but may increase postoperative morbidity. There is currently no consensus on performing omentectomy versus omentum preservation in patients with T3-T4 locally advanced gastric cancer. The purpose of this study is to compare disease-free survival (DFS) between patients who undergo omentectomy and those who undergo omentum preservation. Methods : The OMENTAL trial is a prospective, randomized, controlled, noninferiority, multicenter, and multidisciplinary trial. The primary endpoint is to determine whether omentum preservation during gastrectomy for advanced gastric cancer is noninferior to omentectomy in terms of DFS. The secondary outcomes include postoperative complications, 30-day postoperative mortality, and overall survival. Eligible patients are adults (>18 years) with resectable locally advanced gastric adenocarcinoma (T3-4 or N+, M0), who are eligible to receive perioperative chemotherapy. Patients will be randomized 1:1 to undergo gastrectomy with either omentum preservation or complete omentectomy. Assuming 80% power, an alpha error of 0.05 and a beta error of 0.1, the target sample size is 474 patients (232 each group), considering a 75% prevalence of the condition and a 2% dropout rate. Recruitment is expected to be completed in approximately 4 years. Discussion : The OMENTAL trial will assess whether omentum preservation in the surgical treatment of locally advanced gastric cancer is noninferior to omentectomy in terms of DFS. Its findings may clarify whether routine complete omentectomy is necessary or can be safely avoided, potentially reducing surgical morbidity and overtreatment. Trial registration: ClinicalTrials.gov NCT05747482. Registered on 16 th February 2023
Introduction Drug-related problems (DRP) are common in emergency departments (ED) and may compromise patient safety, highlighting the need to identify patients at greatest risk and prioritize pharmaceutical care. Aim To determine the levels of multidisciplinary consensus on the relevance of candidate factors for identifying patients at risk of DRP in ED, and on the real-time availability and ease of retrieval of the corresponding data in clinical practice. Method Multinational, multidisciplinary consensus study using a modified Delphi method (RAND/UCLA Appropriateness Method) involving healthcare professionals from a wide range of hospitals, predominantly in Spain, with additional representation from Australia and the United States. Participants were recruited from secondary and tertiary care settings across different healthcare systems, providing a diverse representation of emergency care practice. A total of 51 healthcare professionals with expertise in emergency medicine and pharmacotherapy were invited to participate. Response rates were 75% (n=38) during the open consultation, 84% (n=43) in Round 1, and 78% (n=40) in Round 2. The panel included hospital pharmacists, physicians, nurses, and other healthcare professionals involved in emergency care. The primary outcome was consensus on the appropriateness of each DRP risk factor, defined using the RAND/UCLA method based on median scores and interpercentile range analysis. Secondary outcomes included the assessment of real-time data availability and ease of data retrieval in clinical practice. Participants were selected based on their clinical expertise and active involvement in emergency care. Results Following an open consultation, 53 risk factors were evaluated. Participants added 22 new factors, modified 1, and excluded 2. After Round 2, 1 factor (employment status) was classified as inappropriate, 7 as uncertain, and disagreement was observed in 21 factors. High-risk prehospital drug administration, pharmacist intervention requests, and chronic drug use identified by STOPP criteria were among the most relevant factors. Conclusion This study provides a consensus-based set of clinically relevant DRP risk factors in ED. The variability in agreement highlights the complexity of DRP risk stratification and underscores the need for prospective validation studies. These findings support the future development of screening tools to prioritise pharmaceutical care in emergency settings.
