Scientia, Dipòsit d’Informació Digital del Departament de Salut
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Guia per a l’elaboració del Pla de gestió lingüística de les entitats del SISCAT
Get PDFGestió lingüística; Català; Sistema Sanitari Integral d'utilització pública de CatalunyaGestión lingüística; Catalán; Sistema Sanitario Integral de utilización pública de CataluñaCatalan; Public Health System of Catalonia; Managing languageAquesta Guia s'emmarca en la Instrucció 02/2024 del Servei Català de la Salut, que estableix mesures per garantir el compliment dels drets lingüístics dels ciutadans i pacients. Així mateix, es desenvolupa en consonància amb el Pla per garantir l'ús i el coneixement del català en el sistema públic de salut de Catalunya, la qual cosa reafirma el compromís del Departament de Salut amb la normalització de la llengua catalana en l’àmbit sanitari.This guide is part of Instruction 02/2024 of the Catalan Health Service, which establishes measures to guarantee compliance with the linguistic rights of citizens and patients. It is also developed in line with the Plan to guarantee the use and knowledge of Catalan in the public health system of Catalonia.Esta Guía se enmarca en la Instrucción 02/2024 del Servicio Catalán de la Salud, que establece medidas para garantizar el cumplimiento de los derechos lingüísticos de los ciudadanos y pacientes. Asimismo, se desarrolla en consonancia con el Plan para garantizar el uso y conocimiento del catalán en el sistema público de salud de Cataluña, lo que reafirma el compromiso del Departamento de Salud con la normalización de la lengua catalana en el ámbito sanitario
Unmasking paramagnetic rim multiple sclerosis lesions: the advantages of quantitative susceptibility mapping over phase imaging
Get PDFLesions d'esclerosi múltiple; Mapeig quantitatiuLesiones de esclerosis múltiple; Mapeo cuantitativoMultiple sclerosis lesions: Quantitative mappin
Determinacions del perfil genètic de tumors sòlids de l’adult
Get PDFPerfil genètic; Tumors sòlids; Adults; PrecisióPerfil genético; Tumores sólidos; Adultos; PrecisiónGenetic profile; Solid tumors; Adults; AccuracyEn aquest estudi s’ha definit la llista de gens per a cada patologia i tots ells han estat seleccionats atenent a; la seva utilitat diagnòstica per definir els subtipus tumorals en localitzacions tumorals molt concretes; la seva utilitat pronòstica i predictiva, sempre que això comporti un canvi d’actitud terapèutica; la seva utilitat terapèutica per a la indicació de l’ús de fàrmacs diana
Pla d’enquestes de percepció, experiència i satisfacció d’usuaris del Servei Català de la Salut (PLAENSA) : atenció als usuaris amb diagnòstic de lumbàlgia crònica inespecífica; dolor de espalda lumbar
No full textLumbàlgia crònica inespecífica; Atenció usuaris; Enquestes de satisfaccióLumbalgia crónica inespecífica; Atención usuarios; Encuestas de satisfacciónChronic nonspecific low back pain; User care; Satisfaction surveysEnguany s’ha dut a terme el primer estudi de satisfacció PLAENSA sobre la percepció de la qualitat i la satisfacció dels usuaris amb diagnòstic de lumbàlgia crònica inespecífica amb el servei. S’han dut a terme 3.432 enquestes a nivell de tot Catalunya. La satisfacció mitjana del usuaris ha sigut de 6,97 sobre 10, mentre que 69,1% han afirmat que, si poguessin, tornarien a utilitzar el mateix servei. S’han valorat un total de 15 ítems a través d’un qüestionari dissenyat i validat l’any 2023. Els tres ítems més ben valorats pels usuaris l’any 2024 són “P4. Tracte del metge o metgessa del CAP” (90,9%), “P6. Podeu donar la vostra opinió” (84,0%) i “P5. Disposició dels professionals per escoltar i fer-se’n càrrec” (83,8%). Els tres ítems amb més marge de millora són “P10. Temps d’espera fins a la visita amb l’especialista” (33,9%), “P8. Temps d’espera per fer les proves” (44,8%) i la “P9. Temps d’espera fins a començar rehabilitació” (50,3%). El treball de camp s’ha dut a terme durant el primer trimestre de l’any 2024, utilitzant un qüestionari web amb invitació per SMS
Privacy-Preserving Machine Learning (PPML) Inference for Clinically Actionable Models
Get PDFHomomorphic encryption; Machine learning; XGBoostCifrado homomórfico; Aprendizaje automático; XGBoostXifrat homomòrfic; Aprenentatge automàtic; XGBoostMachine learning (ML) refers to algorithms (often models) that are learned directly from data, germane to past experience. As algorithms have constantly been evolving with the exponential increase of computing power and vastly generated data, privacy of algorithms as well as of data becomes extremely important due to regulations and IP rights. Therefore, it is vital to address privacy and security concerns of both data and model together with other performance metrics when commercializing machine learning models. Our aim is to show that privacy-preserving machine learning inference methods can safeguard the intellectual property of models and prevent plaintext models from disclosing information about the sensitive data employed in training these ML models. Additionally, these methods protect the confidentiality of model users’ sensitive patient data. We accomplish this by performing a security analysis to determine an appropriate query limit for each user, using the European Spine Study Group’s (ESSG) adult spinal deformity dataset. We implement a privacy-preserving tree-based machine learning inference and run two security scenarios (scenario A and scenario B) containing four parts with progressively increasing the number of synthetic data points, which are used to enhance the accuracy of the attacker’s substitute model. A target model is generated with particular operation site(s) in each scenario, and substitute models are built with nine-time threefold cross-validation using the XGBoost algorithm with the remaining sites’ data to assess the security of the target model. First, we create box plots of the test sets’ accuracy, sensitivity, precision, and F-score metrics to compare the substitute models’ performance with the target model. Second, we compare the gain values of the target and substitute models’ features. Third, we provide an in-depth analysis to check the inclusion of target model split points in substitute models with a heatmap. Finally, we compare the outputs of public and privacy-preserving models and report intermediate timing results. The privacy-preserving XGBoost model results are identical to the original plaintext model in the aforementioned two scenarios in terms of prediction accuracy. The differences between performance metrics of best-performing substitute models and target models are 0.27, 0.18, 0.25, 0.26 for scenario A, and 0.04, 0, 0.04, and 0.03 for scenario B for accuracy, sensitivity, precision, and F-score, respectively. The differences between target model accuracy and the mean accuracy values of models in each scenario on the substitute models’ test dataset are 0.38 for scenario A and 0.14 for scenario B. Based on our findings, we conclude that machine learning models (i.e., our target models) may contribute to the advancement in the field of application where they are deployed. Ensuring the security of both the model and the user data enables the protection of the intellectual property of ML models, preventing the leakage of sensitive information used in training and model users’ data.European Union’s Horizon Europe Research and Innovation Program (Grant Number: 101079319
The impact of neoadjuvant therapy in patients with left-sided resectable pancreatic cancer: an international multicenter study
Get PDFNeoadjuvant therapy; Pancreatic adenocarcinoma; ResectableTerapia neoadyuvante; Adenocarcinoma pancreático; ResecableTeràpia neoadjuvant; Adenocarcinoma pancreàtic; ResecableBackground: Left-sided pancreatic cancer is associated with worse overall survival (OS) compared with right-sided pancreatic cancer. Although neoadjuvant therapy is currently seen as not effective in patients with resectable pancreatic cancer (RPC), current randomized trials included mostly patients with right-sided RPC. The purpose of this study was to assess the association between neoadjuvant therapy and OS in patients with left-sided RPC compared with upfront surgery.
Patients and methods: This was an international multicenter retrospective study including consecutive patients after left-sided pancreatic resection for pathology-proven RPC, either after neoadjuvant therapy or upfront surgery in 76 centers from 18 countries on 4 continents (2013-2019). The primary endpoint was OS from diagnosis. Time-dependent Cox regression analysis was carried out to investigate the association of neoadjuvant therapy with OS, adjusting for confounders at the time of diagnosis. Adjusted OS probabilities were calculated.
Results: Overall, 2282 patients after left-sided pancreatic resection for RPC were included of whom 290 patients (13%) received neoadjuvant therapy. The most common neoadjuvant regimens were (m)FOLFIRINOX (38%) and gemcitabine-nab-paclitaxel (22%). After upfront surgery, 72% of patients received adjuvant chemotherapy, mostly a single-agent regimen (74%). Neoadjuvant therapy was associated with prolonged OS compared with upfront surgery (adjusted hazard ratio 0.69, 95% confidence interval 0.58-0.83) with an adjusted median OS of 53 versus 37 months (P = 0.0003) and adjusted 5-year OS rates of 47% versus 35% (P = 0.0001) compared with upfront surgery. Interaction analysis demonstrated a stronger effect of neoadjuvant therapy in patients with a larger tumor (Pinteraction = 0.003) and higher serum carbohydrate antigen 19-9 (CA19-9; Pinteraction = 0.005). In contrast, the effect of neoadjuvant therapy was not enhanced for splenic artery (Pinteraction = 0.43), splenic vein (Pinteraction = 0.30), retroperitoneal (Pinteraction = 0.84), and multivisceral (Pinteraction = 0.96) involvement.
Conclusions: Neoadjuvant therapy in patients with left-sided RPC was associated with improved OS compared with upfront surgery. The impact of neoadjuvant therapy increased with larger tumor size and higher serum CA19-9 at diagnosis. Randomized controlled trials on neoadjuvant therapy specifically in patients with left-sided RPC are needed
The Nutritional Phenotyping of Idiopathic Pulmonary Fibrosis Through Morphofunctional Assessment: A Bicentric Cross-Sectional Case–Control Study
Get PDFIdiopathic pulmonary fibrosis; Malnutrition; Morphofunctional assessmentFibrosi pulmonar idiopàtica; Desnutrició; Avaluació morfofuncionalFibrosis pulmonar idiopática; Desnutrición; Evaluación morfofuncionalThere is increasing evidence supporting the use of morphofunctional assessment (MFA) as a tool for clinical characterization and decision-making in malnourished patients. MFA enables the diagnosis of malnutrition, sarcopenia, obesity, and cachexia, leading to a novel phenotype-based classification of nutritional disorders. Bioelectrical impedance analysis (BIVA), nutritional ultrasound® (NU) and computed tomography (CT) are included, along with functional tests like the Timed Up and Go test (TUG). Myoesteatosis, detectable via CT, can occur independently from nutritional phenotypes and has been identified as a significant mortality predictor in idiophatic pulmonary fibrosis (IPF). Our aim is to analyze the prevalence and overlap of nutritional phenotypes in IPF and evaluate the prognostic value of myoesteatosis. Our bicenter cross-sectional study included 82 IPF patients (84.1% male and with a medium age of 71.1 ± 7.35 years). MFA was performed using BIVA, NU, CT at the T12 level (CT-T12), the handgrip strength (HGS) test, and the TUG. CT-T12 BC parameters were analyzed using FocusedON® software, while statistical analyses were conducted with JAMOVI version 2.3.22. All four major nutritional phenotypes were represented in our cohort, with significant overlap. A total of 80.5% met the GLIM criteria for malnutrition, 14.6% had cachexia, 17% were sarcopenic, and 28% were obese. Of the obese patients, 70% were also malnourished, while 100% of sarcopenic obese patients (5.9% of total) had malnutrition. A total of 55% of sarcopenic patients with available CT also had myosteatosis, suggesting muscle quality deterioration as a potential driver of functional impairment. The presence of myosteatosis > 15% in T12-CT was an independent predictor of 12-month mortality (HR = 3.13; 95% CI: 1.01-9.70; p = 0.049), with survival rates of 78.1% vs. 96.6% in patients with vs. without myosteatosis, respectively. To conclude, this study underscores the relevance of MFA in the nutritional characterization of patients with IPF, demonstrating its potential to identify specific phenotypes associated with malnutrition, functional impairment, and the presence of myoesteatosis, thereby providing a valuable tool for clinical decision-making.The authors declare that no funding was received for the conduction of this study. Nonetheless, the authors acknowledge the contributions of the IBIMA (Malaga Biomedical Research Institute and BIONAND Platform), which aided the efforts of the authors. M.M. is supported by the Miguel Servet II program (CPII22-00013) from ISCIII and co-funded by the European Union’s Nicolas Monardes Program from Consejería de Salud de Andalucía (Spain) (C1-0002-2022) and by the projects “PI19/00507” and “PI23/00293” from ISCIII and co-funded by the European Union. M.M. is also supported by UMA18-FEDERJA-285, co-funded by Malaga University, Junta de Andalucía, and FEDER funds, CB06/03/0018, and PI-0297-2018, co-funded by FEDER funds and Consejerıa de Salud y Familia, Junta de Andalucía, Spain. L.G.-S. was supported by the Nicolás Monardes Program from Consejería de Salud de Andalucía (Spain) (C-0028-2018)
Antibióticos en bronquiolitis
Get PDFBronquiolitis; Lactantes; AntibióticosBronquiolitis; Lactants; AntibiòticsBronchiolitis; Infant; AntibioticsRecomanació Essencial sobre el tractament amb antibiòtics en bronquiolitis segons la qual "en lactants, no es recomana l'ús rutinari d'antibiòtics per al tractament de la bronquiolitis". Essencial és un projecte de l'Agència de Qualitat i Avaluació Sanitàries de Catalunya del Departament de Salut per reduir o evitar les pràctiques clíniques de poc valor.Recomendación Essencial sobre el tratamiento con antibióticos en bronquiolitis, según la cual "en lactantes, no se recomienda el uso rutinario de antibióticos para el tratamiento de la bronquiolitis". Essencial es un proyecto de la Agencia de Calidad y Evaluación Sanitarias de Cataluña del Departamento de Salud para reducir o evitar las prácticas clínicas de bajo valor.Essencial recommendation on the use of antibiotics in bronchiolitis, stating that "in infants, the routine use of antibiotics for the treatment of bronchiolitis is not recommended." Essencial is a project of the Catalan Agency for Health Quality and Evaluation, under the Department of Health, aimed at reducing or avoiding low-value clinical practices
Efficacy of Prostate Biopsies via Transperineal and Transrectal Routes for Significant Prostate Cancer Detection: A Multicenter Paired–Matched Study
Get PDFProstate biopsy; Prostate cancer; TransperinealBiòpsia de pròstata; Càncer de pròstata; TransperinealBiopsia de próstata; Cáncer de próstata; TransperinealBackground: A transperineal approach to prostate biopsy is now recommended to reduce the risk of infectious complications associated with the transrectal route. Our aim is to compare the efficacy of transrectal- and transperineal-guided biopsies involving the magnetic resonance imaging (MRI) of index lesions in detecting significant prostate cancer (sPCas), and to evaluate the role of systematic biopsies. Methods: In a prospective and multicenter trial conducted in an opportunistic early detection program for sPCa in Catalonia (Spain), between 2021 and 2023, 4029 men suspected of having PCa underwent multiparametric MRI followed by guided and systematic biopsies. From this cohort, we retrospectively selected 1376 men with reports of the size and localization of their index lesions. A matched group of 325 pairs of men subjected to transrectal and transperineal biopsy were chosen to account for confounding variables. We compared sPCa detection rates determined via index lesions and systematic biopsies, as well as by lesion localization. Results: Transperineal and transrectal biopsies detected sPCa in 49.5% vs. 40.6% overall (p = 0.027), 44.6% vs. 30.8% from index lesions (p = 0.001), and 24.3% vs. 35.1% from systematic biopsies (p = 0.003). SPCa detection rates were higher in transperineal biopsies across all index lesion localizations, with significant increases in the anterior zone (47.8% vs. 20.8% at the mid-base, p = 0.039, and 52.9% vs. 24.2% at the apex, p = 0.024) and central zone (33.3% vs. 5.9%, p = 0.003). With regards to SPCa detected only in systematic biopsies, 10.5% of cases were detected in transrectal biopsies and 4.9% of cases were detected in transperineal biopsies (p = 0.012). Conclusions: Targeted biopsies conducted via the transperineal route showed higher sPCa detection rates than transrectal biopsies, particularly for anterior and apical lesions, with systematic biopsies showing reduced utility.This research was supported by the Instituto de Salut Carlos III (SP) and the European Union (PI20/01666)
Detection of clinically relevant variants in the TP53 gene below 10% allelic frequency: A multicenter study by ERIC, the European Research Initiative on CLL
Get PDFTP53 gene; Allelic frequency; Chronic lymphocytic leukemiaGen TP53; Frecuencia alélica; Leucemia linfocítica crónicaGen TP53; Freqüència al·lèlica; Leucèmia limfocítica crònicaIn chronic lymphocytic leukemia, the reliability of next-generation sequencing (NGS) to detect TP53 variants ≤10% allelic frequency (low-VAF) is debated. We tested the ability to detect 23 such variants in 41 different laboratories using their NGS method of choice. The sensitivity was 85.6%, 94.5%, and 94.8% at 1%, 2%, and 3% VAF cut-off, respectively. While only one false positive (FP) result was reported at >2% VAF, it was more challenging to distinguish true variants <2% VAF from background noise (37 FPs reported by 9 laboratories). The impact of low-VAF variants on time-to-second-treatment (TTST) and overall survival (OS) was investigated in a series of 1092 patients. Among patients not treated with targeted agents, patients with low-VAF TP53 variants had shorter TTST and OS versus wt-TP53 patients, and the relative risk of second-line treatment or death increased continuously with increasing VAF. Targeted therapy in ≥2 line diminished the difference in OS between patients with low-VAF TP53 variants and wt-TP53 patients, while patients with high-VAF TP53 variants had inferior OS compared to wild type-TP53 cases. Altogether, NGS-based approaches are technically capable of detecting low-VAF variants. No strict threshold can be suggested from a technical standpoint, laboratories reporting TP53 mutations should participate in a standardized validation set-up. Finally, whereas low-VAF variants affected outcomes in patients receiving chemoimmunotherapy, their impact on those treated with novel therapies remains undetermined. Our results pave the way for the harmonized and accurate TP53 assessment, which is indispensable for elucidating the role of TP53 mutations in targeted treatment.The work was supported by MH CZ-DRO (FNBr, 65269705) and NW24-03-00114, the project National Institute for Cancer Research (Programme EXCELES, ID Project No. LX22NPO5102)—Funded by the European Union—Next Generation EU; the Swedish Cancer Society, the Swedish Research Council, Region Stockholm and Radiumhemmets Forskningsfonder, Stockholm; the project Towards Precision Medicine: Advanced cellular analytics in biomedical research–PureCell, funded by the Hellenic Foundation for Research and Innovation under the 1st call for research projects EL.ID.EK. for Faculty Members and researchers and the supply of high-value research equipment. The research leading to these results has received funding from AIRC under 5 per Mille 2018 - ID. 21 198 program – P.I. Foà Roberto, G.L. Ghia Paolo. We acknowledge the CF Genomics supported by the NCMG research infrastructure (LM2023067 funded by MEYS CR) for their support in obtaining scientific data presented in this paper