Scientia, Dipòsit d’Informació Digital del Departament de Salut
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Institut d’Assistència Sanitària: memòria 2023
No full textSistema sanitari públic; Activitat assistencial; MemòriaSistema sanitario público; Actividad asistencial; MemoriaPublic health system; Healthcare activity; Annual reportL’Institut d’Assistència Sanitària (IAS) és una empresa pública que forma part del Sistema Sanitari Integral d’Utilització Pública (SISCAT) de la Generalitat de Catalunya. Aquest document recull l’activitat realitzada per l’IAS durant l’any 2023
2025 Updated version v1.0 SEOM-GEMCAD-TTD clinical guidelines for the systemic treatment of metastatic colorectal cancer (2022)
Full text linkTractament sistèmic; Càncer colorectal metastàticSystemic treatment; Metastatic colorectal cancerTratamiento sistémico; Cáncer colorrectal metastásic
Contemporary carotid artery stenting practices and peri-procedural outcomes in different European countries: ROADSAVER study multicentric insights
Full text linkCarotid artery; Geographical variation; StentsArteria carótida; Variación geográfica; StentsArtèria caròtida; Variació geogràfica; StentsBackground
Regional variations in patient selection and procedural techniques for carotid artery stenting have been well documented. However, their impact on procedural outcomes, especially with the use of dual-layer micromesh stents, is not fully understood.
Methods
This prospective, multi-center observational study included 1965 patients with asymptomatic or symptomatic carotid artery stenosis treated with the Roadsaver dual-layer micromesh stent. The primary outcome measure was the 30-day rate of major adverse events, defined as any death or stroke occurring within 30 days post-procedure. This sub-analysis compared patient characteristics and procedural techniques across 13 participating countries and investigated differences in outcomes via logistic regression modelling.
Results
Patient demographics, comorbidities, and symptom presentation varied widely among countries. Similarly, the frequency of use of duplex ultrasound and diffusion-weighted magnetic resonance imaging at baseline and 30-day follow-up differed. Procedural approaches also varied, with differences in femoral access site selection (18.2% to 100.0%), use of embolic protection devices (0.0% to 100.0%), pre-dilatation (4.3% to 46.7%) and post-dilatation (66.7% to 100.0%). Although 30-day major adverse event rates differed across the compared countries, after adjusting for post-dilatation balloon pressure (categorized as no post-dilatation vs. ≤ 11atm vs. > 11atm), and the number of enrolled patients per study site, the difference became statistically non-significant.
Conclusion
Our study reveals variability in patient selection, procedural carotid stenting practices and clinical outcomes across European countries. The differences in 30-day any death or stroke rates between countries may be attributed to differing post-dilatation practices and the number of enrolled patients per study site.
Level of evidence
Level 3, observational study.The study was funded by Terumo Europe
Activities of the clinical pharmacist in the intensive care units
Full text linkFarmacia hospitalaria; Farmacéutico clínico; Paciente críticoHospital pharmacy; Clinical pharmacist; Critical patientFarmàcia hospitalària; Farmacèutic clínic; Pacient críticEl objetivo principal de la actividad llevada a cabo en una unidad de cuidados intensivos y en general en todas las unidades de hospitalización, es facilitar todos los medios humanos y materiales para ofrecer la mejor atención terapéutica a los pacientes ingresados. El trabajo en equipos multidisciplinarios, compuestos por especialistas en medicina intensiva como responsables de los enfermos, médicos de otras especialidades, enfermería especializada, fisioterapeutas, nutricionistas y farmacéuticos clínicos, es un enfoque óptimo para alcanzar el objetivo propuesto. Las actividades del farmacéutico clínico pueden desarrollarse a diferentes niveles (básico, intermedio y excelente) dependiendo del grado de implicación, el tiempo de dedicación, la capacitación y los recursos disponibles. El presente artículo pretende establecer una guía de trabajo inicial, mediante recomendaciones dirigidas a la actividad a desarrollar por el farmacéutico clínico en la UCI en relación con el cuidado del paciente crítico y la mejora de la calidad, que sirva de referencia para aquellos farmacéuticos que vayan a desarrollar actividades de atención farmacéutica en unidades de cuidados intensivos.The main objective of the activity carried out in an intensive care unit and in general in all hospitalization units, is to provide all the human and material resources to offer the best therapeutic care to admitted patients. Work in multidisciplinary teams, made up of specialists in Intensive Care Medicine as those responsible for the patients, doctors from other specialties, specialized nursing, physiotherapists, nutritionists and clinical pharmacists is an optimal approach to achieve the proposed objective. The activities of the clinical pharmacist can be developed at different levels (basic, intermediate and excellent) depending on the degree of involvement, the time dedicated, the training and the available resources. This article aims to establish an initial work guide, through recommendations aimed at the activity to be developed by the clinical pharmacist in the ICU in relation to critical patient care and quality improvement, which serves as a reference for those pharmacists who go to develop pharmaceutical care activities in critical patients
PIPMED: pla integral de la política del medicament 2025-2027 [tríptic]
No full textPlan integral de la política del medicamento; PIPMED; SISCATComprehensive drug policy plan; PIPMED; SISCATPolítica del medicament; Ús dels medicaoments; SISCATAquest Pla integral de la política del medicament neix amb la voluntat de respondre als reptes presents i futurs en l’àmbit del medicament, integrant criteris d’eficiència, innovació i responsabilitat social. Té com a objectiu establir un marc d’actuació coherent i alineat amb els valors del sistema de salut, promovent un ús racional dels medicaments, afavorint la recerca i la innovació terapèutica, i garantint la sostenibilitat del sistema públic de salut. L’abast del PIPMED és el següent: la prestació farmacèutica que inclou els medicaments i els productes sanitaris, i engloba el conjunt d’actuacions encaminades a garantir que els pacients rebin de manera adequada a les seves necessitats clíniques. Al Sistema Sanitari Integral d’Utilització Pública de Catalunya (SISCAT)
Effect of the Number of Vaccine Doses Before Starting Anti-CD20 Therapy on Seroprotection Rates Against Hepatitis B Virus in People With MS
Full text linkVaccine; Anti-CD20 therapy; Hepatitis B virusVacuna; Terapia anti-CD20; Virus de la hepatitis BVacuna; Teràpia anti-CD20; Virus de l'hepatitis BBackground and Objectives Hepatitis B vaccination (HBV) requires 6 months to complete and is recommended for patients with multiple sclerosis (PWMS), particularly those who are candidates for anti-CD20 therapy. However, limited data exist on HBV immunogenicity in PWMS receiving diseasemodifying therapies (DMTs) and the impact of starting anti-CD20 therapy during immunization. We aimed to evaluate HBV immunogenicity in PWMS starting anti-CD20 therapy during vaccination, focusing on the number of doses received before anti-CD20 initiation. Methods Weconducted aretrospective analysis of a prospective cohort of adult PWMS at a single center in Spain, from April 2015 to May 2023. Eligible participants completed a 4-dose HBV course and underwentpostvaccination serologic testing. We assess seroprotection rates (SRs), defined as the percentage of patients achieving anti-hepatitis B surface antibody titers ≥10 IU/L, focusing on those who switched to anti-CD20 therapy during vaccination, based on doses received before starting anti-CD20 and type of DMT at vaccination start. A multivariate generalized linear model (GLM) was used to identify factors associated with higher seroconversion. Downloaded from https://www.neurology.org by 84.88.74.3 on 18 March 2025 Results Atotal of 289 PWMS (median [interquartile range (IQR)] age, 47.7 [42.8–54.4] years; 65.7% female; median [IQR] disease duration, 14.8 [6.7–21.2] years) were included. SRs progressively declined with fewer doses before anti-CD20 initiation, from 92.8% (95% CI 87.1–96.5) for 4 doses to 24.0% (95% CI 9.4–45.1) for 1 dose. Patients transitioning from sphingosine 1-phosphate (S1P) modulators showedthe lowestSRat25.0%(95%CI7.3–52.4). The multivariate GLM confirmed these findings, with 3 doses (SR ratio 3.23 [95% CI 1.68–6.23]; p = 0.0005) or 4 doses (SR ratio 3.76 [95% CI 1.96–7.24]; p < 0.0001) before antiCD20 therapy significantly associated with higher SRs, while starting S1P modulators at vaccination onset was significantly associated with lower SRs (SR ratio 0.42 [95% CI 0.23–0.78]; p =0.0058). Female sex (SR ratio 1.15 [95% CI 1.01–1.32]; p = 0.0389) and younger age (SR ratio 0.90 [95% CI 0.83–0.97]; p = 0.0036) were also significantly associated with higher SRs.This study has been funded by Instituto de Salud Carlos III (ISCIII) through the project PI19/01606 and co-funded by the European Union
Diccionari de bioètica
No full textDiccionari; Bioètica; TerminologiaDiccionario; Bioética; TerminologíaDictionary; Bioethics; TerminologyL’obra ha estat concebuda com una eina de consulta per a resoldre els dubtes terminològics en l’àmbit de la bioètica dels professionals de les ciències de la salut i també dels
estudiants d’aquestes disciplines. A més, també pot ser d’interès per a tots els lectors
que, com a usuaris de l’atenció sanitària, sentin curiositat o vulgui endinsar-ne en aquest
àmbit del coneixement
Efficacy of omalizumab in food allergic adults - A retrospective analysis
Full text linkAnaphylaxis; Food allergy; ImmunotherapyAnafilaxi; Al·lèrgia alimentària; ImmunoteràpiaAnafilaxia; Alergia alimentaria; InmunoterapiaBackground
IgE-mediated food allergy poses a significant public health concern, currently with no approved therapies for adults in Europe. Omalizumab (OMA) used as monotherapy or in conjunction with oral immunotherapy (OIT) has been suggested as an efficacious treatment for severe food allergy. The aim of this study was to analyze real-world data from food-allergic patients treated with OMA.
Methods
We included food-allergic patients treated with OMA between 2002 and 2022 throughout Europe. Treatment responders (TR) were identified based on the unresponsiveness to related food allergens (determined by food challenge), reduction in the severity of food allergy and absence of anaphylactic reactions.
Results
Sixty-two patients (female n = 39/62, 62.9%; mean age 30.6 years) were included into this analysis, most of whom were polysensitized to more than 2 food allergens (n = 40/62, 64.5%); 45/62 patients (72.6%) received OMA in conjunction with OIT, while the remaining patients underwent OMA monotherapy. The eliciting food allergens were tree nuts (n = 27/62, 43.5%), cow's milk (n = 26/62, 41.9%), and vegetables (n = 25/62, 40.3%). In most cases, OMA was initiated with 300 mg q4w (n = 51/62, 82.3%) dosing. Treatment was tolerated exceptionally well.
Fifty-two (52/62) patients (83.9%) were classified as treatment responders. Six (6/62) patients (9.7%) developed unresponsiveness, 6/62 (9.7%) had a reduction of the severity of food allergy, and 40/62 (64.5%) had no further anaphylactic reactions during treatment. One (1/62) patient (1.6%) undergoing monotherapy was a non-responder, exhibiting repeated anaphylactic reactions to accidental exposures, and 10/62 patients (16.1%) reported anaphylactic reactions during treatment. In most of these cases, cofactors (n = 5/10, 50%) were present.
Conclusion
Our real-world evidence data indicate efficacy and tolerability of OMA for the treatment of IgE-mediated food allergy with and without OIT. As the onset of food related reactions upon treatment was frequently linked to the presence of cofactors, these should be identified and considered in patients with food allergy—not only for diagnosis, but also in treatment settings.A. Alexiou is funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) as part of the clinical research unit (CRU339): Food allergy and tolerance (FOOD@) – project-number 428447634
Is the information provided by large language models valid in educating patients about adolescent idiopathic scoliosis? An evaluation of content, clarity, and empathy
Full text linkAdolescent idiopathic scoliosis; Large language models; Patient educationEscoliosi idiopàtica de l'adolescent; Models de llenguatge extens; Educació pel pacientEscoliosis idiopática del adolescente; Modelos de lenguaje extenso; Educación para el pacientePurpose
Large language models (LLM) have the potential to bridge knowledge gaps in patient education and enrich patient-surgeon interactions. This study evaluated three chatbots for delivering empathetic and precise adolescent idiopathic scoliosis (AIS) related information and management advice. Specifically, we assessed the accuracy, clarity, and relevance of the information provided, aiming to determine the effectiveness of LLMs in addressing common patient queries and enhancing their understanding of AIS.
Methods
We sourced 20 webpages for the top frequently asked questions (FAQs) about AIS and formulated 10 critical questions based on them. Three advanced LLMs—ChatGPT 3.5, ChatGPT 4.0, and Google Bard—were selected to answer these questions, with responses limited to 200 words. The LLMs’ responses were evaluated by a blinded group of experienced deformity surgeons (members of the European Spine Study Group) from seven European spine centers. A pre-established 4-level rating system from excellent to unsatisfactory was used with a further rating for clarity, comprehensiveness, and empathy on the 5-point Likert scale. If not rated 'excellent', the raters were asked to report the reasons for their decision for each question. Lastly, raters were asked for their opinion towards AI in healthcare in general in six questions.
Results
The responses among all LLMs were ‘excellent’ in 26% of responses, with ChatGPT-4.0 leading (39%), followed by Bard (17%). ChatGPT-4.0 was rated superior to Bard and ChatGPT 3.5 (p = 0.003). Discrepancies among raters were significant (p 3.0 on 5.0) and did not demonstrate any differences among LLMs. However, GPT-3.5 struggled with language suitability and empathy, while Bard’s responses were overly detailed and less empathetic. Overall, raters found that 9% of answers were off-topic and 22% contained clear mistakes.
Conclusion
Our study offers crucial insights into the strengths and weaknesses of current LLMs in AIS patient and parent education, highlighting the promise of advancements like ChatGPT-4.o and Gemini alongside the need for continuous improvement in empathy, contextual understanding, and language appropriateness.Open Access funding enabled and organized by Projekt DEAL
A probabilistic model of bilateral lymphatic spread in head and neck cancer
Full text linkProbabilistic model; Bilateral lymphatic spread; Head and neck cancerModelo probabilístico; Propagación linfática bilateral; Cáncer de cabeza y cuelloModel probabilístic; Propagació limfàtica bilateral; Càncer de cap i collCurrent guidelines for elective nodal irradiation in oropharyngeal squamous cell carcinoma (OPSCC) recommend including large portions of the contralateral lymphatic system in the clinical target volume (CTV-N), even for lateralized tumors with no clinical lymph node involvement in the contralateral neck. This study introduces a probabilistic model of bilateral lymphatic tumor progression in OPSCC to estimate personalized risks of occult disease in specific lymph node levels (LNLs) based on clinical lymph node involvement, T-stage, and tumor lateralization. Building on a previously developed hidden Markov model for ipsilateral lymphatic spread, we extend the approach to contralateral neck involvement. The model represents LNLs I, II, III, IV, V, and VII on both sides of the neck as binary hidden variables (healthy or involved), connected via arcs representing spread probabilities. These probabilities are learned using Markov chain Monte Carlo (MCMC) sampling from a dataset of 833 OPSCC patients, enabling the model to reflect the underlying lymphatic progression dynamics. The model accurately and precisely describes observed patterns of lymph node involvement with a compact set of interpretable parameters. Midline extension of the primary tumor is identified as the primary risk factor for contralateral involvement, with advanced T-stage and extensive ipsilateral involvement further increasing risk. Occult disease in contralateral LNL III is highly unlikely if upstream LNL II is clinically negative, and in contralateral LNL IV, occult disease is exceedingly rare without LNL III involvement. This model offers an interpretable, probabilistic framework to inform personalized elective CTV-N volume reduction. For lateralized tumors that do not cross the midline, it suggests the contralateral neck may safely be excluded from elective irradiation. For tumors extending across the midline but with a clinically negative contralateral neck, elective irradiation could be limited to LNL II, reducing unnecessary exposure of normal tissue while maintaining regional tumor control