Introducción y objetivos Evaluar la cultura de seguridad es fundamental para mejorar la seguridad de los pacientes. Existen múltiples instrumentos, pero tras una búsqueda bibliográfica, se acordó utilizar la encuesta SOPS® hospital Survey 2.0 de la Agency for Healthcare Research and Quality (AHRQ). El objetivo del presente estudio fue realizar una adaptación lingüística al catalán, porque en nuestro contexto es idioma cooficial y para muchos profesionales es de uso principal. Material y métodos Se realizó una primera traducción por dos profesionales bilingües nativos catalán y español. Otros dos profesionales, también bilingües, revisaron y consensuaron una versión. Posteriormente, una experta en adaptaciones lingüísticas de lengua materna inglesa llevó a cabo una traducción de la versión catalana al inglés y valoró la equivalencia semántica entre esta traducción y la versión original, clasificando los ítems en: A, cuando eran totalmente equivalentes; B, cuando presentaban diferencias menores causadas por problemas gramaticales o contexto cultural, y C, para aquellos con diferencias de contenido. En una reunión de consenso se valoraron y cambiaron en caso necesario los elementos clasificados como B y C. También se evaluó la equivalencia semántica entre la versión catalana y la española. Se valoraron los términos/frases entre 0 y 10 (entre no equivalente a totalmente equivalente). Resultados Tras la traducción del catalán al inglés y su comparación con la versión original de Estados Unidos fue necesario adaptar algunos términos, surgiendo la versión definitiva catalana. Así mismo, existió un elevado consenso por parte de los evaluadores en la equivalencia semántica de las versiones catalana y española. Conclusiones Se dispuso de una versión en catalán que está alojada en el repositorio BiblioPro.
Objetivo Desarrollar e implementar una Escala de Niveles de Intensidad Terapéutica (NIT-Mar) en un consorcio hospitalario y evaluar su uso. Método Adaptación de una escala de intensidad terapéutica mediante reunión de expertos y posterior evaluación a partir de un estudio observacional retrospectivo en pacientes fallecidos por SARS-CoV-2 entre marzo y junio de 2020 en un consorcio hospitalario universitario. Se analizaron: características clínicas, utilización de la escala, cambios de NIT, grado de consenso en la toma de decisiones y concordancia entre el NIT asignado y las medidas terapéuticas aplicadas. Resultados Se incluyeron 210 pacientes. En el 74,8% se utilizó la escala NIT. No hubo diferencias significativas en edad, género o comorbilidades entre pacientes con y sin NIT. El consenso en la toma de decisiones se logró en el 87,9% de los casos, principalmente entre profesionales (77%) y familias (72,6%), pero solo en el 12,7% con el propio paciente. En el 49,7% de los casos el NIT se modificó durante el ingreso. La concordancia entre el NIT y las medidas aplicadas fue del 85,3%. Conclusión La escala NIT-Mar se utilizó ampliamente desde su implementación, favoreciendo la toma de decisiones en situaciones de alta presión asistencial. Su flexibilidad permitió ajustes en la intensidad terapéutica según la evolución del paciente. Esta herramienta puede mejorar la comunicación entre equipos, la planificación asistencial y la seguridad del paciente.
BACKGROUND:Pain in knee osteoarthritis (KOA) often shows a limited correlation with radiographic severity, complicating clinical assessment and highlighting the relevance of central pain mechanisms. Functional magnetic resonance imaging (fMRI) enables the investigation of brain regions such as the amygdala and nucleus accumbens, which are increasingly recognized as key components of the affective-motivational dimension of chronic pain and may show differential activation across clinical treatment contexts. This study is part of the HOLOA Project (Clinical and virtual examination of patients for holistic and objective description of the osteoarthritis progression mechanisms). METHODS:We conducted a cross-sectional observational study nested within the HOLOA cohort. Thirty-one patients with KOA (20 managed conservatively [CM] and 11 observed in the surgical treatment context) with Kellgren Lawrence (KL) grades 2-3 were included. Participants underwent two fMRI paradigms involving pressure stimulation (Knee Interline and Tibial Surface tests). Clinical assessment included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), and Numeric Rating Scale (NRS). Group comparisons and correlation analyses were performed to examine associations between clinical measures and brain activation patterns. RESULTS:Groups were broadly comparable with no statistically significant differences in demographic or radiographic severity measures. These patients showed higher WOMAC and PCS scores, indicating greater functional impairment and pain catastrophizing. Across the whole cohort, painful stimulation elicited robust activation of classical pain-processing regions, while no significant amygdala or nucleus accumbens activation was observed at the group level. However, nucleus accumbens activity was positively associated with PCS scores. In between-group analyses, patients observed in the surgical treatment context exhibited significant bilateral amygdala activation during Tibial Surface stimulation, which was absent in the conservatively managed group, and reported higher post-test NRS scores. CONCLUSION:Limbic system activation and pain catastrophizing were associated with the surgical treatment context in patients with knee osteoarthritis within a similar range of radiographic severity. The observed involvement of the amygdala and nucleus accumbens underscores the relevance of affective-motivational and cognitive processes in chronic KOA pain. These findings support the value of integrating clinical, psychological, and neurobiological perspectives when interpreting symptom burden and treatment context in knee osteoarthritis.
Epidemiological data from Sapin are lacking, especially in a publication relating Spanish data and prevalence of programmed cell death ligand-1 (PD-L1) expression. This study aimed to evaluate the prevalence of PD-L1 expression by Combined Positive Score (CPS) ≥ 5 in patients with advanced esophagogastric adenocarcinoma (aEGAC) in Spain. This observational, retrospective, and multicenter study collected sociodemographic and clinical data from adult patients with locally advanced unresectable, recurrent, or metastatic EGAC across 21 centers in the AGAMENON-SEOM registry. CPS PD-L1 expression was centrally analyzed using the IHC 28–8 pharmDx. A total of 166 patients were included, with 144 valid and evaluable samples. The primary tumor locations were stomach (70.1
BACKGROUND:Patients with muscle-invasive bladder cancer who are ineligible for cisplatin-based chemotherapy proceed directly to radical cystectomy with pelvic lymph-node dissection. Perioperative therapy may improve outcomes in this population. METHODS:In this phase 3, open-label trial, participants with muscle-invasive bladder cancer who were ineligible for or declined cisplatin-based chemotherapy were randomly assigned to perioperative (neoadjuvant and adjuvant) enfortumab vedotin, an antibody-drug conjugate directed at nectin-4, plus pembrolizumab and surgery (9 total cycles of enfortumab vedotin [1.25 mg per kilogram of body weight on days 1 and 8] plus 17 total cycles of pembrolizumab [200 mg on day 1 every 3 weeks], with surgery after 3 cycles) or surgery alone (control). The primary end point was event-free survival. Key secondary end points were overall survival and pathological complete response (absence of viable tumor after surgical resection). Other secondary end points included safety. RESULTS:A total of 344 participants underwent randomization (170 in the enfortumab vedotin-pembrolizumab group and 174 in the control group). At data cutoff, median follow-up was 25.6 months (range, 11.8 to 53.7). Surgery was performed in 87.6% of participants in the enfortumab vedotin-pembrolizumab group and in 89.7% in the control group. At 2 years, estimated event-free survival was 74.7% in the enfortumab vedotin-pembrolizumab group and 39.4% in the control group (hazard ratio for an event or death, 0.40; 95% confidence interval [CI], 0.28 to 0.57; two-sided P<0.001); estimated overall survival was 79.7% and 63.1% (hazard ratio for death, 0.50; 95% CI, 0.33 to 0.74; two-sided P<0.001). A pathological complete response had occurred in 57.1% and 8.6% of the participants (estimated difference, 48.3 percentage points; 95% CI, 39.5 to 56.5; two-sided P<0.001). Adverse events occurred in all participants in the enfortumab vedotin-pembrolizumab group (grade ≥3, 71.3%; grade ≥3 drug-related, 45.5%) and in 64.8% in the control group (grade ≥3, 45.9%). CONCLUSIONS:Perioperative enfortumab vedotin plus pembrolizumab and surgery led to significantly better event-free and overall survival outcomes and a greater percentage of participants with pathological complete response than surgery alone in a predominantly cisplatin-ineligible population with muscle-invasive bladder cancer. Safety was also assessed. (Funded by Merck Sharp and Dohme, a subsidiary of Merck [Rahway, NJ]; KEYNOTE-905 ClinicalTrials.gov number, NCT03924895.).
