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Paragangliomas are infrequent neuroendocrine tumours whose only criterion for malignancy is presence of metastases; thus, all paragangliomas show malignant potential. Actually, different risk factors have been analyzed to predict metastases but they remain unclear. To analyze clinical, histological, and genetic factors to predict the occurrence of metastasis. A multicentre retrospective observational analysis was performed between January 1990 and July 2019. Patients diagnosed with paraganglioma were selected. Clinical, histological, and genetic features were analyzed for the prediction of malignancy. A total of 83 patients diagnosed with paraganglioma were included, of which nine (10.8%) had malignant paraganglioma. Tumour size was greater in malignant tumours than in benign (6 cm vs. 4 cm, respectively; p = 0.027). The most frequent location of malignancy was the thorax-abdomen-pelvis area observed in six cases (p = 0.024). No differences were observed in histological differentiation, age, symptoms, and catecholaminergic production. The most frequent genetic mutation was SDHD followed by SDHB but no differences were observed between benign and malignant tumours. In the univariate analysis for predictive factors for malignancy, location, tumour size, and histological differentiation showed statistical significance (p = 0.025, p = 0.014, and p = 0.046, respectively); however, they were not confirmed as predictive factors for malignancy in the multivariate analysis. In this study, no risk factors for malignancy have been established; therefore, we recommend follow-up of all patients diagnosed with paraganglioma.

ResumenObjetivoIdentificar similitudes y diferencias en la empatía, en las habilidades de trabajo colaborativo interprofesional, y en las habilidades de aprendizaje médico permanente entre médicos residentes españoles y latinoamericanos que inician su formación especializada en hospitales docentes españoles.DiseñoEstudio observacional mediante encuesta.EmplazamientoCinco hospitales docentes de la provincia de Barcelona, España.ParticipantesMédicos residentes, españoles y latinoamericanos, que inician el primer año de los programas de formación médica especializada.Mediciones principalesLa empatía mediante la escala Jefferson de empatía médica. La colaboración interprofesional mediante la escala Jefferson de actitud hacia el trabajo colaborativo en equipos medicina-enfermería. El aprendizaje mediante la escala Jefferson de aprendizaje médico permanente.ResultadosEn una muestra de 156 residentes, 110 españoles y 40 latinoamericanos, los españoles mostraron una mayor orientación empática que los latinoamericanos (p

Background Participation rates in colorectal cancer screening are below recommended European targets. Aim To evaluate the effectiveness of an alert in primary care electronic medical records (EMRs) to increase individuals’ participation in an organised, population-based colorectal cancer screening programme when compared with usual care. Design and setting Cluster randomised controlled trial in primary care centres of Barcelona, Spain. Method Participants were males and females aged 50–69 years, who were invited to the first round of a screening programme based on the faecal immunochemical test (FIT) ( n = 41 042), and their primary care professional. The randomisation unit was the physician cluster ( n = 130) and patients were blinded to the study group. The control group followed usual care as per the colorectal cancer screening programme. In the intervention group, as well as usual care, an alert to health professionals (cluster level) to promote screening was introduced in the individual’s primary care EMR for 1 year. The main outcome was colorectal cancer screening participation at individual participant level. Results In total, 67 physicians and 21 619 patients (intervention group) and 63 physicians and 19 423 patients (control group) were randomised. In the intention-to-treat analysis screening participation was 44.1% and 42.2% respectively (odds ratio 1.08, 95% confidence interval [CI] = 0.97 to 1.20, P = 0.146). However, in the per-protocol analysis screening uptake in the intervention group showed a statistically significant increase, after adjusting for potential confounders (OR, 1.11; 95% CI = 1.02 to 1.22; P = 0.018). Conclusion The use of an alert in an individual’s primary care EMR is associated with a statistically significant increased uptake of an organised, FIT-based colorectal cancer screening programme in patients attending primary care centres.

Pivotal phase studies of telaprevir (TLV) and boceprevir (BOV) showed 10-56% rates of early treatment interruption. However, there have been no reports on the sustained virological response (SVR) rates of these patients.To assess the SVR rate in a large cohort of patients who discontinued triple therapy with TLV or BOV for reasons other than stopping rules and to identify variables predicting SVR.A survey was sent to 15 hospitals in Catalonia asking them to report all TLV/BOV treatments finished by 31 May 2014. Demographic, clinical, laboratory, liver fibrosis and therapeutic data were recorded for treatments with early discontinuation. Logistic regression analysis, ROC curves and prognostic assessment of the variables identified were calculated.Twelve hospitals responded to the survey, representing 467 treatments and 121 (21.2%) early discontinuations, 76 (62.8%) due to stopping rules and 45 (37.2%) for other reasons. Early discontinuation was more frequent with BOV [38.2% (50/131) versus 21.1% (71/336) p0.005], mainly due to stopping rules [78% (39/50) versus 52.1% (37/71); p=0.004]. SVR was achieved in 21/121 patients (17.4%), 19/71 (26.8%) treated with TLV and 2/50 (4.0%) treated with BOV. In patients discontinuing treatment for reasons other than stopping rules, SVR was achieved in 19/37 (55.9%) treated with TLV and in 2/11 (18.2%) treated with BOV. The SVR rate in patients treated with TLV who discontinued due to a severe adverse event was 61.5% (16/26). A logistic regression analysis was performed only with triple therapy with TLV and early discontinuation. The predictive variables of SVR were undetectable HCV-RNA at treatment week 4 and treatment length longer than 11 weeks. Treatment duration longer than 11 weeks showed the best accuracy (0.794), with a positive predictive value of 0.928.Early discontinuation of TLV-based triple therapy due to reasons other than stopping rules still have a significant SVR rate (55.9%). Undetectable HVC-RNA at week 4 of treatment and treatment duration longer than 11 weeks are predictive of SVR in this subset of patients.

ResumenObjetivoConocer la incidencia anual de exposiciones accidentales a sangre y fluidos biológicos en el personal sanitario de un hospital comarcal, y describir sus características, situaciones asociadas y seguimiento.MétodoEstudio longitudinal retrospectivo de los accidentes biológicos notificados anualmente, de forma voluntaria, por los trabajadores expuestos en la Fundació Hospital de l’Esperit Sant (en Santa Coloma de Gramenet, Barcelona) entre los años 2005 y 2014. Se realiza un estudio descriptivo de las variables relacionadas con el trabajador expuesto, la exposición, su mecanismo de producción y el paciente fuente de la exposición. Se han calculado las incidencias de exposición por cada 100 camas y por categoría laboral.ResultadosSe han declarado 318 exposiciones, el 89,62% percutáneas y el resto contaminaciones de piel no intacta o mucosas. La incidencia media de exposiciones percutáneas de todo el periodo ha sido de 17,6 por cada 100 camas/año (límites 10,3 en 2013 y 24,5 en 2005). Los médicos son el colectivo profesional con mayor riesgo (5,29 exposiciones por cada 100 médicos). Más del 50% se han producido en el área de cirugía. El 44,2% refiere una actividad profesional media en el centro igual o inferior a 1 año. El pinchazo ha sido la lesión percutánea más frecuente. No se han declarado casos de transmisión viral ocupacional.ConclusionesLa incidencia ocupacional de exposiciones percutáneas declaradas en el hospital sufre oscilaciones significativas a lo largo del periodo analizado. El riesgo de exposición está relacionado con la categoría laboral, la experiencia profesional, el área de trabajo y la actividad realizada.AbstractObjectiveTo determine the annual incidence of healthcare professionals’ accidental exposure to blood and body fluids in a community hospital and describe their characteristics, associated situations and follow-up.MethodA longitudinal, retrospective study of biological accidents voluntarily reported on a yearly basis by exposed healthcare professionals at Fundació Hospital de l’Esperit Sant (in Santa Coloma de Gramenet, Barcelona, Spain), between 2005 and 2014. A descriptive analysis of the variables related to the exposed professional, the exposure itself, its production mechanism and the source patient was conducted. The rate of exposure was calculated per 100 occupied beds and by job category.Results318 exposures were reported; 89.62% were percutaneous and the remainder were non-intact skin or mucous contamination. The mean percutaneous exposure incidence rate from 2005 to 2014 was 17.6 per 100 occupied beds/year (limits 10.3 in 2013 and 24.5 in 2005). Doctors were exposed to the greatest risk (5.29 exposures per 100 doctors). Over 50% occurred in a surgical setting. 44.2% of exposed healthcare professionals had been working at the centre for 1 year or less on average. Puncture was the most common percutaneous lesion. No cases of occupational viral transmission were reported.ConclusionsThe rate of percutaneous exposure reported in this hospital fluctuated significantly throughout the analysis period. Risk of exposure is related to job category, work experience, the setting and the activity performed.

To determine the annual incidence of healthcare professionals' accidental exposure to blood and body fluids in a community hospital and describe their characteristics, associated situations and follow-up.A longitudinal, retrospective study of biological accidents voluntarily reported on a yearly basis by exposed healthcare professionals at Fundació Hospital de l'Esperit Sant (in Santa Coloma de Gramenet, Barcelona, Spain), between 2005 and 2014. A descriptive analysis of the variables related to the exposed professional, the exposure itself, its production mechanism and the source patient was conducted. The rate of exposure was calculated per 100 occupied beds and by job category.318 exposures were reported; 89.62% were percutaneous and the remainder were non-intact skin or mucous contamination. The mean percutaneous exposure incidence rate from 2005 to 2014 was 17.6 per 100 occupied beds/year (limits 10.3 in 2013 and 24.5 in 2005). Doctors were exposed to the greatest risk (5.29 exposures per 100 doctors). Over 50% occurred in a surgical setting. 44.2% of exposed healthcare professionals had been working at the centre for 1 year or less on average. Puncture was the most common percutaneous lesion. No cases of occupational viral transmission were reported.The rate of percutaneous exposure reported in this hospital fluctuated significantly throughout the analysis period. Risk of exposure is related to job category, work experience, the setting and the activity performed.

Resumen Objetivo Identificar similitudes y diferencias en la empatía, en las habilidades de trabajo colaborativo interprofesional, y en las habilidades de aprendizaje médico permanente entre médicos residentes españoles y latinoamericanos que inician su formación especializada en hospitales docentes españoles. Diseño Estudio observacional mediante encuesta. Emplazamiento Cinco hospitales docentes de la provincia de Barcelona, España. Participantes Médicos residentes, españoles y latinoamericanos, que inician el primer año de los programas de formación médica especializada. Mediciones principales La empatía mediante la escala Jefferson de empatía médica. La colaboración interprofesional mediante la escala Jefferson de actitud hacia el trabajo colaborativo en equipos medicina-enfermería. El aprendizaje mediante la escala Jefferson de aprendizaje médico permanente. Resultados En una muestra de 156 residentes, 110 españoles y 40 latinoamericanos, los españoles mostraron una mayor orientación empática que los latinoamericanos (p