Spanish Experience Research Articles

Intensive Care to Facilitate Organ Donation: Can We Emulate the Spanish Experience?

Intensive Care to Facilitate Organ Donation: Can We Emulate the Spanish Experience?

Outcomes of controlled DCDD lung transplantation after thoraco-abdominal vs abdominal normothermic regional perfusion: The Spanish experience

ObjectiveThoraco-abdominal normothermic regional perfusion (TA-NRP) has emerged as a strategy for evaluating and recovering the heart in controlled donation after the circulatory determination of death (cDCDD). However, its impact on lung grafts remains largely unknown. We aimed to assess the impact of TA-NRP on the outcomes of recipients of cDCDD lungs. MethodsThis is a retrospective, multicenter, nationwide study describing the outcomes of cDCDD lung transplants (LTs) performed in Spain from January 2021 to November 2023. Patients were divided in two groups based on the recovery technique: TA-NRP with the simultaneous recovery of the heart versus abdominal NRP (A-NRP) without simultaneous heart recovery. The primary endpoint was the incidence of Primary Graft Dysfunction (PGD) grade 3 at 72 hours. Secondary endpoints included the overall incidence of PGD, days on mechanical ventilation, ICU and hospital length of stay, early survival rates, and mid-term outcomes. Results283 cDCDD LTs were performed during the study period, 28 (10%) using TA-NRP and 255 (90%) using A-NRP. No differences were observed in the incidence of PGD grade 3 at 72 hours between the TA-NRP and the A-NRP group (0% vs. 7.6%; p=0.231), though the overall incidence of PGD was significantly lower with TA-NRP (14.3%% vs. 41.5%; p=0.005). We found no significant differences between the groups regarding other post-transplant outcome variables. ConclusionsTA-NRP allows the simultaneous recovery of both the heart and the lungs in the cDCDD scenario with appropriate LT outcomes comparable to those observed with the A-NRP approach.

Institutionalization of Social Economy Public Policies as a Strategy against Global Challenges: Evidence from the Spanish Experience

This paper explores the process of increasing institutionalization of the social economy, focusing on its critical role in addressing global challenges, especially during crises. By examining mainstream international documents, the study identifies challenges confronting the social economy and spotlights Spain as a model for effective institutionalization practices in terms of recognition, regulation, institutional support, policies and programs and external institutional leadership. Two distinct forms of institutionalization are distinguished: socio-cognitive and political. Spain's leadership is noteworthy for integrating these forms, translating conceptual ideals into tangible policies.

Re-irradiation for progressive Diffuse Intrinsic Pontine Glioma (DIPG): The Spanish experience

IntroductionDiffuse intrinsic pontine glioma (DIPG) is the most common malignant brainstem tumour in children. Despite advances in understanding its biology, current treatments have shown minimal impact on overall survival in this fatal disease. Focal radiotherapy (RT) is the only treatment proven to improve symptoms and extend progression-free survival. Albeit palliative, re-irradiation (rRT) has emerged as the best alternative for progressive disease. This study presents the Spanish experience with re-irradiation in DIPG. ResultsBetween April 2015 and December 2023, 44 paediatric patients with progressive DIPG underwent rRT in 16 Spanish institutions. Median time from diagnosis to progression was 9.9 months (range, 4.2–24.3 months). Median dose of rRT was 20 Gy (range, 18–40 Gy) in 2 Gy fractions (range, 1.3–4 Gy). Twenty-two patients (50 %) received other treatments besides RT. Clinical improvement was seen in 77.3 %, and radiological improvement in 60 %. Treatment was well tolerated (1 case toxicity >grade 2 related to rRT). Median overall survival was 15.5 months (range, 8.2–63.2 months), with a median time from rRT to death of 4.2 months (range, 0.6–10.3 months). Longer time between diagnosis and rRT (>10 months) and dose of rRT >20 Gy were statistically significantly correlated with better overall survival. There was no survival benefit in patients receiving additional treatments. ConclusionsRe-irradiation is safe and effective in progressive DIPG patients, not only improving symptoms but also prolonging survival. However, the ideal candidates for rRT remain undefined, as well as the best irradiation scheme. Prospective studies are needed.

Evaluating the Safety of the Intragastric Balloon: Spanish Multicenter Experience in 20,680 Cases and with 12 Different Balloon Models.

Intragastric balloon (IGB) is a minimally invasive and reversible option for obesity treatment. There is a worldwide growing number of different IGB models. The efficacy and safety profile for each model must be demonstrated. We aim to evaluate IGB safety profile according to the experience of the Spanish Bariatric Endoscopy Group (GETTEMO). A survey of 37 IGBs safety-related questions was sent to all GETTEMO members, to retrospectively collect a multicenter Spanish registry. Incidence, causes, and resolution of both major and minor complications and adverse events (AEs), including legal consequences, differentiated for each balloon model were evaluated. Secondary outcome was weight loss data to confirm efficacy. Twenty-one Spanish hospitals experienced in IGBs responded. The overall data encompassed 20,680 IGBs, including 12 different models. Mean %TBWL of 17.66 ± 2.5% was observed. Early removal rate due to intolerance was 3.62%. Mean major complications rate was 0.70% (> 1% in Spatz2, HB, and Spatz3 models), mainly complicated gastric ulcer. Minor AEs rate was 6.37%, mainly esophagitis. Nine cases (0.04%) required surgery. A single case of mortality (0.0048%) occurred. Seven lawsuits (0.0034%) were received, all with favorable resolution. In the Spanish experience accumulating 20,680 IGBs and including 12 different balloon models, a low incidence rate of major complications and minor AEs are observed (0.70% and 6.37%, respectively), mostly resolved with medical/endoscopic management. IGB shows good tolerance and efficacy profile. These safety data are within the accepted quality standards.

Rotspanier. Debate with Regard to the Classification of the Spanish Prisoners Deported to the Mauthausen Concentration Camp

Spanish prisoners deported to the Mauthausen Nazi concentration camp were treated and classified in an anomalous and problematic fashion that did not correspond to the real reasons for their detention. Thus, despite being prosecuted as Rotspaniers – ‘red Spaniards’ – a category initially employed to designate those Germans who had fought in the Spanish Civil War in support of the republican government, they were systematically forced to wear a blue badge that, according to the codes usually implemented in camps, classified them as ‘emigrants’, an equally strange category that was applied to all those Jews or political exiles who had fled Germany following the rise of Nazism but had been arrested upon their return to the country. This reality, however, was not shared by the other Spaniards distributed across the other camps in the system or by the other Rotspaniers present in Mauthausen, who were given the red badge that indicated they were political prisoners. This is the anomaly addressed by this article, which, based on study of the administrative sources at Mauthausen and thorough analysis of ‘protective custody’ as a legal instrument employed by the Nazi authorities to neutralize their enemies, enables us to revisit the debate and propose a new interpretative framework through which to re-evaluate the Spanish experience in the network of German camps.

The registers of pediatric patients with home artificial nutrition. The Spanish experience

Background: the number of infants and children who receive artificial nutrition at home has been steadily increasing over the last decades, as better outcomes for children with chronic conditions have been achieved. In order to evaluate the need of resources to implement the technique it is necessary to know how many patients benefit from home artificial nutrition. This information can be estimated from the register of patients, when available. Methods: in this paper the characteristics of all registers were reviewed, especially those devoted to pediatric patients. Results: only two pediatric registers are active in 2023: the Canadian register and the Spanish one. NADYA register from the Spanish Society for Clinical Nutrition and Metabolism (SENPE) and the recent REPAFI, form the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition. The most valuable register from the British Society, BANS, stopped providing information in 2018. Conclusion: despite the fact of acknowledging the importance of having gathered information on the prevalence and incidence of home artificial nutrition, to fit resources to necessities, the number of active registers is quite short.

DIPG-63. RE-IRRADIATION FOR PROGRESSIVE DIFFUSE INTRINSIC PONTINE GLIOMA (DIPG): THE SPANISH EXPERIENCE

Abstract BACKGROUND Despite advances in its biological understanding, current treatments for diffuse intrinsic pontine glioma (DIPG) have shown minimal impact on overall survival in this fatal disease. Radiotherapy (RT) is the only therapeutic intervention that has demonstrated efficacy in improving symptoms and prolonging progression-free survival. In addition, re-irradiation (rRT) is emerging as an alternative treatment for advanced disease, albeit palliative. This study presents the Spanish experience with re-irradiation in DIPG. METHODS We retrospectively reviewed demographic, clinical and RT data of patients with DIPG treated with rRT in Spain. RESULTS Between April 2015 and December 2023, 44 Pediatric patients with progressive DIPG underwent rRT in 16 Spanish institutions. Median time from diagnosis to progression was 10 months (range, 4.2-24.3). Median dose of rRT was 20 Gy (range, 18-40) in a median of 2 Gy fractions (range, 1.3-4). Twenty-one patients (47.7%) underwent additional treatments in addition to RT. Clinical and radiological improvements were observed in 77.3% and 60% of cases, respectively. Treatment was well tolerated with only 3 patients experiencing severe toxicity (one requiring a VP-shunt, and two finalizing rRT due to bronchoaspirations). Median overall survival was 15.1 months (range, 8.2-61.2), with a median time from rRT to death of 4.2 months (range, 0.6-10.3). Compared to patients who experienced earlier relapses, those who relapsed after 10 months exhibited superior overall survival (21.8 vs. 12.9 months; p < 0.001%), and a longer interval from rRT to death (6.2 vs. 3.8 months; p = 0.058). There was no survival benefit in patients receiving additional treatments. CONCLUSIONS rRT effectively improves symptoms and prolongs survival in many progressive DIPG patients. However, the ideal candidates for rRT remain undefined. The retrospective nature of the study makes it difficult to assess the true impact of additional treatments. We encourage prospective research into the combination of rRT with other therapies.

Exploring independent living initiatives for people with intellectual disabilities: insights from the Spanish case

In the past four decades, Independent Living (IL) has gained prominence in inspiring services for people with intellectual disabilities. Yet, its practical application faces challenges within a field still influenced by medical-rehabilitative and paternalistic perspectives. This study seeks to explore the fundamental characteristics that IL models assume within the field of intellectual disabilities, focusing on the Spanish experience, identifying pioneering projects, influential models, and their ripple effects. A comprehensive mapping of IL projects has been conducted, analyzing publicly available information on 86 identified cases. In seven significant cases, in-depth interviews were conducted with people responsible for their development. Our analysis sheds light on some emerging tensions, with a focus on what is identified as a family-centered approach, an emphasis on skills-oriented services, and an overreliance on housing accessibility. Finally, this paper offers recommendations to enhance these initiatives and foster the integration of IL in the intellectual disability context.

Bone mineral density in women with type 2 diabetes mellitus and postmenopause: a single center spanish experience

Bone mineral density in women with type 2 diabetes mellitus and postmenopause: a single center spanish experience

Clinical characteristics and complications of gestational diabetes mellitus: a single center spanish experience

Clinical characteristics and complications of gestational diabetes mellitus: a single center spanish experience

The Influence of Pre-Trip Medical Spanish Education on a US-Based, Medical Student Service Trip: A Cohort Study

Background: International service trips are increasingly common in medical school curricula. Medical Spanish is an essential tool in healthcare interactions with Spanish-speaking patients globally. Medical Spanish classes are offered at many medical schools, but it is not known whether they increase confidence for medical students on Spanish-speaking service trips. Methods: A prospective cohort study of medical students attending one of two sister campuses who completed pre- and post-international medical service trip questionnaires. Data collected includes demographics, confidence, and perceived experiences. Data analyses involved a multivariable regression assuming an ordered multinomial response, FREQ procedure, and the GLIMMIX procedure on SAS STAT v.9.4. Results: Demographics significantly associated with confidence categories are female sex, length of Spanish education, previously having lived in a Spanish country, and experience speaking Spanish with patients. Confidence communicating in Spanish shows the highest gain in significant categories post-trip while confidence working with interpreters and feeling adequately trained to treat Hispanics showed the lowest. Participants having taken Medical Spanish before did not improve their confidence. However, participants with prior Medical Spanish experience reported significantly higher benefit from this education in that it gave them an advantage and helped them connect better with patients. Conclusion: Our findings reinforce the importance of language-concordance and confidence in patient interactions while demonstrating that prior Medical Spanish experience may not significantly improve confidence on a Spanish-speaking international trip, especially among non-fluent students. Spanish experience and proficiency should not be a deterring factor for students looking to go on a medical trip.

Effectiveness and efficiency of support schemes in promoting renewable energy sources in the Spanish electricity market

This research paper delves into the central mechanisms implemented in Spain to foster the adoption of clean energy projects. The study scrutinizes various mechanisms established from 2005 onwards, evaluating their efficacy in achieving the desired outcome of supporting clean energy project implementation. The aim is to comprehensively assess the associated costs, effectiveness, and attainment of renewable energy objectives stemming from implementing diverse support schemes. This paper explores the effectiveness of feed-in tariffs and feed-in premium mechanisms in promoting the integration of new renewable energy generation into the power system. However, the Spanish experience suggests that exhaustive planning control is imperative to prevent excessive support costs that could jeopardize the entire market and cause a significant rise in final energy costs. The research studies the support schemes and associated market distortion and presents the roadmap from regulated tariffs to a “total market” for wind and solar energy. The findings demonstrate that, under proper supervision and planning, a transitional retribution scheme effectively promotes renewable energy plant integration. Finally, the analysis examines the need to regulate the excess benefits that non-emitting power sources receive in a marginal price market, as this can lead to market imbalances and a substantial increase in final costs. These plans serve as a crucial tool in achieving the decarbonization objectives of the European Power System.

Analysis of missed clinic visits, preferred languages, and telemedicine in a pediatric gastroenterology practice.

Previous studies have demonstrated a relationship between socioeconomic disparities and missed clinic visits (MCV). However, the relationship between patient-preferred language and MCVs, particularly with respect to telemedicine, remains relatively underexplored. We sought to characterize the associations between MCV and patient-level predictors, including preferred language, in a large single-center pediatric gastroenterology, hepatology, and nutrition practice. This retrospective longitudinal cohort study included all missed or completed outpatient visits in the Gastroenterology, Hepatology, and Nutrition Programs at Boston Children's Hospital from January 1, 2016to May 20, 2022. Univariate and multivariate hierarchical generalized linear mixed models were employed to identify associations between visit- and patient-level predictors and an MCV outcome. A total of 300,201 visits from 70,710 patients residing in Massachusetts were included. Univariate analyses revealed higher MCV odds for Hispanic patients and those from areas with the highest Social Vulnerability Index (SVI), and these odds increased with telemedicine (Hispanic in-person odds ratio [OR] 5.21 [(95% confidence interval) 4.93-5.52] vs. telemedicine OR 8.79 [7.85-9.83]; highest SVI in-person OR 5.28 [4.95-5.64] vs. telemedicine OR 7.82 [6.84-8.96]). Controlled multivariate analyses revealed that among six language groups, only Spanish language preference was associated with higher MCV odds, which increased with telemedicine (Spanish in-person adjusted OR [aOR]1.35 [1.24-1.48] vs. telemedicine aOR 2.1 [1.83-2.44]). Patients preferring Spanish experience unique barriers to care beyond those faced by other language preference groups, and telemedicine may exacerbate these barriers.

Hematopoietic stem cell transplantation in children with chronic granulomatous disease: the Spanish experience.

Hematopoietic stem cell transplantation (HCT) can cure chronic granulomatous disease (CGD). However, transplant-associated morbidity or mortality may occur, and it is still controversial which patients benefit from this procedure. The aim of this retrospective study was to evaluate the outcome of pediatric patients who received HCT in one of the Spanish pediatric transplant units. Thirty children with a median age of 6.9 years (range 0.6-12.7) were evaluated: 8 patients received a transplant from a sibling donor (MSD), 21 received a transplant from an unrelated donor (UD), and 1 received a haploidentical transplant. The majority of the patients received reduced-intensity conditioning regimens based on either busulfan plus fludarabine or treosulfan. Relevant post-HCT complications were as follows: i) graft failure (GF), with a global incidence of 28.26% (CI: 15.15-48.88), 11.1% in patients with MSD (1.64-56.70) and 37.08% in unrelated donors (19.33-63.17); and ii) chronic graft-versus-host disease (GVHD), with an incidence of 20.5% (8.9-43.2), 11.1% in patients with MSD (1.64-56.70) and 26.7% in unrelated donors (10.42-58.44). Post-HCT infections were usually manageable, but two episodes of pulmonary aspergillosis were diagnosed in the context of graft rejection. The 2-year OS was 77.3% (55.92-89.23). There were no statistically significant differences among donor types. HCT in patients with CGD is a complex procedure with significant morbidity and mortality, especially in patients who receive grafts from unrelated donors. These factors need to be considered in the decision-making process and when discussing conditioning and GVHD prophylaxis.

Spanish contribution to the development and application of probabilistic safety analysis: Experience and future challenges

The development of Probabilistic Safety Analysis, which began in Spain in 1986, is based on the document “Integrated Program on Development and Use of Probabilistic Safety Analysis in Spain” adopted by the Spanish regulatory body. A second edition of this document in 1998 considered the activities needed to apply its principles in different fields. Since then, the Spanish regulatory body, universities and the nuclear industry have contributed to their development and application, especially in nuclear power plants. This paper provides an overview of the Spanish experience in three areas: the regulatory framework, developments, and applications. We also provide information on opportunities for improvement and future challenges.

Environmental sustainability and circular economy in SMEs: a qualitative approach from the Spanish experience

Environmental sustainability and circular economy in SMEs: a qualitative approach from the Spanish experience

The trials of judge Garzón and the enforceability of decisions by human rights treaty bodies in Spain

ABSTRACT In 2021, the UN Human Rights Committee (HRC) held Spain responsible for violations of Articles 14(1), 14(5) and 15 (1) of the ICCPR in the Garzón v Spain case. The purposes of this article are three-fold. Firstly, it provides an analysis of the ‘Francoism’ case and the ‘Gürtel’ case, the two trials held by the Spanish Supreme Court (SSC) against Judge Garzón, which the HRC declared were ‘arbitrary and did not comply with the principles of judicial independence and impartiality’, and an assessment of their political and legal aftermaths. Secondly, it assesses the dim prospects for Spain complying with the HRC’s views on the Garzón case by providing an updated and comprehensive statistical account of Spain’s extremely low record of compliance with previous HRC’s decisions. Thirdly, it provides an analysis of the new opportunities for judicial enforceability in cases of non-compliance by Spain with the views of the HRC in the wake of the SSC’s landmark judgement on the González Carreño v. Spain case and subsequent case law. The conclusion considers the enhanced potential role of domestic courts in fostering the enforceability of decisions by quasi-adjudicatory human rights bodies both in Spain and in the light of the Spanish experience.

Формирование и функционирование социального государства в Испании

The article presents the history of the Spanish social support system development from the Middle Ages to the beginning of the XXI century. The purpose of the article is to analyze the background and features of the Spanish social policy. To study the development of the Spanish welfare state, the article uses the comparative historical approach and the analysis of institutions, legal documents and statistical data. The experience of Spain and other countries is compared, approaches to the typology of social policy are considered, economic factors and transformations of support measures and principles of redistribution are analyzed. Despite the fact that some trends manifested in Spain earlier than in other countries, the Spanish welfare state formed relatively late. The country has developed a unique configuration of social support, combining the German logic of a corporatist approach with a British universalist one. The Spanish experience of organizational decisions in the field of social policy is of interest, since Spain is facing the problem of an aging population against a background of persistently high unemployment creating serious pressure on the social system, which retains its functionality due to a periodic revision of priorities.

Proficiency Test for Blood Alcohol Concentration in Forensic Laboratories: Spanish Experience

Ethanol is a well-known psychoactive drug whose intake strongly affects driving capability.