Spanish Society Research Articles

Current Status of the clinical role in Spanish interventional radiology: An online survey among the Spanish Society of Vascular and Interventional Radiology (SERVEI) members

PurposeThis work aims to provide an overview of the current reality of clinical practice in interventional radiology in Spain, evaluating clinical activity, interventional radiologists’ opinion on the importance of playing a proactive clinical role, and the barriers they encounter in doing so. Materials and MethodsThe study was based on an 18-question survey divided into four categories: general aspects, clinical activity, opinion on a proactive clinical role, and barriers. The questionnaire, validated by the Spanish Society of Vascular and Interventional Radiology (SERVEI), was distributed to all members (n = 483) via email. A descriptive statistical analysis was performed. ResultsThe response rate was 26.5% (128/483). A total of 44.5% (57/128) had admitting privileges, 70.3% (90/128) had consultations, 32.8% (42/128) did ward rounds, and 94.5% (121/128) participated in multidisciplinary committees. Most spent just 0%–10% of their workday on clinical activity. A total of 43.7% (56/128) reported providing longitudinal care for their patients. On a Likert scale from 1 to 10, the importance of performing pre-procedural consultations was rated a mean of 8.3 (IQR: 10–8), post-procedural consultations 8.1 (IQR: 10–7), and care during hospitalization 7.7 (IQR: 10–6). The main obstacles were a lack of time/excessive workload and inadequate professional resources. ConclusionsSpanish interventional radiologists demonstrated a clear awareness of the importance of providing longitudinal patient care. However, they reported only partially taking on the clinical responsibilities for the patients they treated.

Los maestros contra la RAE. Obstáculos y enredos de la oficialización de la gramática escolar académica en España (1875-1900)

This work aims to study the main challenges that academic school grammar faced in Spain for its consolidation in classrooms from the time of the Restoration, when its texts (Compendio and Epítome) became official again for the teaching of the Spanish language in public schools. Our analysis focuses specifically on examining the various news, reviews, and articles found in the Spanish printed press, a representative textual sample, not only of how the issue is experienced in Spanish society, but also of the different attitudes and opinions of intellectuals of the time regarding the matter, especially from the teachers, which maintained strong resistance against the repression actions carried out by the government and the Academy itself for the maintenance (and expansion) of their privileges and the consolidation of their doctrine in the classrooms.

Status of the implementation of pharmacogenetics in clinical practice in Spain: from regional to national initiatives.

Pharmacogenetics (PGx) has the potential to improve patient care, allowing to transform medical interventions by providing personalized therapeutic strategies. Scientific evidence supports the use of PGx in clinical practice and international organizations are developing clinical guidelines to facilitate the utilization of PGx testing. However, clinical implementation of PGx is limited and unequal worldwide. This review summarizes regional and national Spanish initiatives to implement PGx in the clinical practice. Diverse strategies to implement PGx in healthcare are applied across countries or even in the different regions of a specific country. Such was the case of Spain, a European country with 17 Autonomous Regions and two Autonomous Cities, each one with capacity to manage their own healthcare systems. Nevertheless, during the past years, many initiatives and strategies have been launched in Spain to develop different aspects of PGx. Importantly, the National Healthcare System has approved a PGx testing catalogue. This review highlights the crucial work and efforts of scientific societies (like the Spanish Society of Pharmacogenetics and Pharmacogenomics), of experts in PGx, of healthcare providers and of governmental parties in the implementation of PGx to personalize patient therapy, focused in Spain.

Recommendations for the use of nuclear medicine imaging in patients with neuroblastoma.

Neuroblastoma (NB) is the most common extracranial solid cancer in children. Despite intensive multimodality treatment, long-term survival of patients with high-risk NB, which comprises more than half of all cases, remains poor. Nuclear medicine is key in diagnosis, staging, response assessment and long-term follow-up of NB. The emergence of novel tracers and the increasing complexity of studies require updated guidelines for nuclear medicine imaging in NB. Standardising diagnostic techniques are essential for improving study comparability and ensuring test quality. This article aims to provide a comprehensive review of NB radionuclide diagnostic imaging, including its characteristics, accuracy, advantages, and limitations. It offers practical recommendations to multidisciplinary teams responsible for treating patients with NB. This review summarises the opinions of leading experts from the Neuroblastoma Spanish Group within the Spanish Society of Paediatric Haematology and Oncology (SEHOP) and the Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM).

Los indicadores de calidad de la Sociedad Europea de Cardiología en fibrilación auricular en centros de excelencia en España: el registro SEC-EXCELENTE FA

Introduction and objectives By 2022, 9 centers had been accredited by the Spanish Society of Cardiology for the atrial fibrillation (AF) process. Our objective was to evaluate the performance of these centers based on the quality indicators (QIs) proposed by the European Society of Cardiology (ESC) in 2020.Methods Adults with AF who were attended in the cardiology departments of participating centers during the second week of May 2019 were included in a retrospective registry (n = 797, age 72 ± 11 years, 60% male). Key ESC QIs were assessed.Results CHA2DS2-VASc, HAS-BLED scores, and serum creatinine levels were documented in 24.9%, 6.1%, and 96.2% of patients, respectively. Anticoagulation was appropriately prescribed in 90.6% of high-risk patients according to the CHA2DS2-VASc score, but was inappropriately prescribed in 57.8% of low-risk patients. Among all patients, 84.1% received high-quality anticoagulation. Inappropriate antiarrhythmic drugs were prescribed in 7.2% of patients with permanent AF, 2.9% of those with structural heart disease, and 0.0% of those with end-stage kidney disease. Catheter ablation was offered to 70% of patients with symptomatic paroxysmal or persistent AF after the failure or intolerance of 1 antiarrhythmic drug. All modifiable risk factors were documented in 59.3% of patients. Rates of all-cause mortality, ischemic stroke or transient ischemic attack, and major bleeding were 8.1, 0.8, and 2.56 per 100 patients/y, respectively. QIs for anticoagulation and outcomes were similar between general cardiology and tertiary referral centers.Conclusions Although accredited centers in Spain demonstrated good performance in many of the ESC QIs for AF, there remains room for improvement. These data could serve as a starting point for enhancing the quality of care in this population.

Clinical Practice Guideline for detection and management of diabetic kidney disease: a consensus report by the Spanish Society of Nephrology

Clinical Practice Guideline for detection and management of diabetic kidney disease: a consensus report by the Spanish Society of Nephrology

The Ether Concept from Spanish Physics Textbooks (1840–1950)

AbstractThe presence of the ether concept in the contents of 73 Spanish physics textbooks (secondary and first course university level) published in the period 1840–1950 is studied. The textbooks are a specially interesting learning tool in the Spanish society of this period, due to the rural character of the country, the capacity of the textbooks for frequent and repeated use as well as for dissemination over the entire state. Particularly, the content about heat, light and electricity is investigated. Whether the concept of ether appears in the general principles of the textbooks or not is also studied. Moreover, the work considers the evolution of the concept of ether by decades, showing different examples of how the ether was used to explain different physics phenomena. Furthermore, the social and historical context in which the textbooks were developed is discussed in detail. Outstanding amongst the different conclusions that are drawn is the disappearance of the concept of the ether during the third and fourth decades of the twentieth century.

Differences in clinical features of patients with heart failure and reduced, mildly reduced, and preserved ejection fraction in a contemporary cohort: is the clinical profile changing?

Abstract Introduction Heart failure is a serious health problem and continues to have a high mortality and incidence of decompensations, despite advances in its management. The type of HF, defined by the LVEF value, has a great influence on treatment, since not all drugs and procedures have been shown to improve prognosis in the different subtypes of HF (reduced-HFrEF, mildly reduced-HFmrEF, and preserved-HFpEF). In addition, there are differences in clinical characteristics and comorbidities that may also influence these aspects, although the demographic and social changes that have occurred in recent years may have changed this perspective. Purpose To analyze in a contemporary registry of HF patients followed in specialized HF units in Spain the differences in clinical and demographic characteristics and comorbidities among the three subtypes of HF. Methods We analyzed data from the registry of the SEC-Excelente-IC quality accreditation program of the Spanish Society of Cardiology, with 1716 patients with HF included between 2019 and 2021 by 45 specialized HF units accredited by the SEC. Patients were included consecutively in two 1-month cutoffs (March and October) in that period. The clinical and demographic characteristics and comorbidities of the patients were compared according to the type of HF. Results Of the 1716 patients, 55.5% were HFrEF, 11.9% HFmrEF and 32.6% HFpEF. Figure 1 shows the main demographic and cardiovascular characteristics of the three subgroups. The median LVEFs were 30% (23-35), 45% (42-48) and 58% (53-65), respectively. Figure 2 shows the prevalence of major comorbidities. Patients with HFpEF were older and female in higher proportion, and presented a significantly higher prevalence of atrial fibrillation, valvular heart disease, obesity, hypertension, and anemia. Patients with HFrEF had a higher prevalence of coronary artery disease, smoking, admissions for HF in the previous year, and left bundle branch block. There were no differences between the three groups in the remaining comorbidities, including chronic kidney disease and chronic respiratory diseases. The characteristics of HFmrEF were intermediate between HFrEF and HFpEF (figures 1 and 2). Conclusions In our contemporary cohort of real-life HF patients, slight differences were observed between the 3 types of HF, particularly in relation to age, proportion of women, and prevalence of cardiac diseases. However, the prevalence of most of the major comorbidities did not show significant differences between the 3 groups, suggesting that a shift toward greater similarity in clinical characteristics between the 3 types of HF may be occurring.

Utility of telephone text messages in secondary prevention after acute coronary syndrome

Abstract Introduction The recurrence of events in patients after an acute coronary syndrome (ACS) represents a great challenge for the health systems due to its high prevalence, morbidity and mortality, and cost. For this reason, secondary prevention measures with low cost and easy to implement are necessary. The objective is to evaluate the usefulness of telephone text messages (TTM) in the control of risk factors and reduction of events in the first year after an ACS. Methods Single-blind 1:1 randomized clinical trial in consecutive patients discharged with ACS between May 2019 and October 2021 in our center. The intervention group received a monthly TTM for 12 months with the recommendations of the Spanish Society of Cardiology regarding secondary prevention measures. Both groups followed the usual review protocol of our center in a specific ischemic heart disease consultation at 3 and 12 months after discharge. The center lacks cardiac rehabilitation. The objectives of the study at 12 months were: total and cardiovascular death, myocardial infarction, stroke, weight, blood pressure, LDL, HDL, triglycerides, glycosylated hemoglobin, smoking habit, and hours of exercise per week. The evaluator in charge of collecting data after the end of the year was unaware of the assignment group. Results N= 370. The patient profile was the usual one for ACS, with a mean age of around 65 years and 25% diabetic, with no differences in any of the baseline characteristics between both groups. An invasive approach was performed in almost all of the subjects, with percutaneous intervention in three-quarters of the cases and also without significant differences in the type of treatment, percentage of multivessel disease, and left main disease between both groups. Only a lower number of stents per patient was recorded in the control group. There were also no differences in medical treatment between both groups. The results are shown in the table. Conclusions In our study, monthly TTM had no influence on the control of risk factors or clinical events during the first year of follow-up after an ACS, and therefore it is not cost-effective to allocate resources for this purpose.

Differences in the optimization of pharmacological treatment in patients with heart failure and reduced ejection fraction and advanced chronic kidney disease

Abstract Introduction Chronic kidney disease is very prevalent in patients with HF, makes their treatment difficult and worsens their prognosis, especially when it is advanced CKD (glomerular filtration rate <30 mL/min/m2). Renal insufficiency increases the risk of drug intolerance and an increase in serious side effects, which can lead to underuse, with consequent negative effects on patient prognosis. Purpose To analyze in a contemporary registry of HF patients followed in specialized HF units in Spain the achievement of dose targets for the most used drugs in HF with reduced ejection fraction (HFrEF) and the impact of advanced CKD. Methods We analyzed 914 patients with HFrEF consecutively included between 2019 and 2021 in the registry of the SEC-Excelente-IC quality accreditation program of the Spanish Society of Cardiology in 45 centers. We evaluated the proportion of patients treated with ACEI, ARA, ARNI, MRA, beta-blockers and SGLT2 inhibitors at the registry inclusion visit, the causes of non-prescription, and the achievement of the maximum dose recommended in the ESC clinical practice guidelines or the maximum tolerated dose in these patients, comparing the GFR groups, greater or less than 30 ml/min/m2. Results Of the 914 patients, 8.9% had a GFR<30 mL/min/m2. Their age was 76.9±9.7 years, 39.7% women, mean LVEF 32.8±9-6%. Patients with GFR<30 received in a significantly lower proportion all HF drugs except diuretics, ARBs and potassium chelators: sacubitril-valsartan 30.5% vs 59.2%; MRAs 31.7 vs 77.8%; SGLT2 inhibitors 34.1 vs 52.9% (p<0.001; Figure 1). The main reason for non-use was intolerance/contraindication for beta-blockers and "other" for the rest of the drugs (Figure 1). The proportion of patients in whom the maximum recommended, or maximum tolerated dose was reached was low in both groups, less than 40-50% for all drugs except MRA. There were no significant differences between the two groups in relation to the degree of renal dysfunction, although there was a tendency for the recommended doses to be obtained more frequently in the group with lower GFR (Figure 2). Conclusions In our contemporary cohort of real-life patients with HFrEF and advanced CKD, the use of recommended drugs for HF was significantly lower than in those patients with better renal function. However, where they were used, maximum recommended or tolerated doses were achieved in a higher proportion of patients. This indicates that with adequate selection it is possible to achieve the objectives proposed by the clinical practice guidelines in this complex group of patients.

The Elderly Bias of the Spanish Welfare State (1958–2012)

Abstract The Spanish welfare state is strongly biased toward sustaining the elderly’s welfare, rather than children’s. We study the evolution of that bias since 1958 through National Transfer Accounts (NTA). NTA disentangle how people produce, consume, and save along their life cycle, and how resources move among generations through different mechanisms (families, markets, and governments). We extend the available NTA (2000–2012) to the past and show that Spanish social policies were biased toward the elderly since their early stages. The gradual increase in social expenditure and the aging of Spanish society have turned such bias into a serious challenge for the economy.

Incidence of 1-year mortality, heart failure admissions and decompensation in patients with heart failure followed in HF units in Spain. Differences according to type of units

Abstract Introduction Heart failure is a serious health problem and continues to have a high mortality and incidence of decompensation, despite advances in its management. The introduction of specific multidisciplinary HF units has improved the management of patients with this disease, thanks to better organization and management of available diagnostic and therapeutic resources. The HF Association of the ESC and the Spanish Society of Cardiology have defined 3 types of HF units (community, specialized, and advanced) according to their structure, complexity, and portfolio of services. Purpose To analyze in a contemporary registry of patients with HF followed up in HF units in Spain whether the results in terms of mortality and HF decompensations during follow-up are similar or different between the 3 types of units. Methods We analyzed data from the registry of the SEC-Excelente-IC quality accreditation program of the Spanish Society of Cardiology, with 1,716 patients with HF included between 2019 and 2021 by 45 SEC-accredited HF units. Patients were included consecutively in two 1-month cutoffs (March and October) in that period. Units were defined as community, specialized, and advanced according to ESC HFA and SEC criteria. We compared the incidence of death, HF admissions and total decompensations at 1-year follow-up between community and specialized/advanced units. Results Of the 1716 patients, 55.5% were treated in community units, 65.9% in advanced units, and 20.9% in advanced HF units. Figure 1 shows the main characteristics and treatment used in the 3 types of units. The community units treated older patients and more HFpEF, and the use of NRA and AID was lower, with no differences in the remaining characteristics, comorbidities, or treatments (Figure 1). Figure 2 shows the incidence of events at 1 year. Total mortality was 27.5% in community and 15.5% in specialized/advanced (p<0.001). HF admissions (39.7 vs 29.2%; p=0.019), HF decompensations without admission (16.4 vs 11.3%; p=0.074), total decompensations (56.1 vs 40.5%; p=0.003), and combined HF death/admissions (45.2 vs 31.4%; p=0.005) were statistically higher in community units. Control in specialized/advanced units was an independent protector factor for all events (mortality: HR 0.59, 0.43-0.82; p=0.002; HF admissions: HR 0.61, 0.42-0.90; p=0.012; total HF decompensations: HR 0.58, 0.42-0.81; p=0.001). Conclusions One-year prognosis of HF patients continues to be poor, with high rates of mortality and decompensations. Patients attended in community HF units was significantly worse in our country during the study period. Although this may be due in part to the small differences between the characteristics of the patients followed in the different types of units, it seems necessary to improve the network organization of HF care with the aim of achieving greater equity in the treatment of HF in Spain.

Heart failure and advanced chronic kidney disease: differences in characteristics, treatment and outcomes in patients with glomerular filtration rate greater or less than 30 ml/minute/m2

Abstract Introduction Heart failure (HF) is a serious health problem and continues to have a high mortality and incidence of decompensation, despite advances in its management. Chronic kidney disease (CKD) is very prevalent in patients with HF, hinders their treatment and worsens their prognosis, especially when it is advanced CKD (glomerular filtration rate-GFR <30 ml(min/m2). It is important to know the differential characteristics of these patients to improve their management. Purpose To analyze in a contemporary registry of HF patients followed in specialized HF units in Spain the differences in clinical characteristics and treatment between patients with HF and advanced CKD. Methods We analyzed data from the registry of the SEC-Excelente-IC quality accreditation program of the Spanish Society of Cardiology, with 1716 patients with HF included between 2019 and 2021 by 45 specialized HF units accredited by the SEC. Patients were included consecutively in two 1-month cutoffs (March and October) in that period. The clinical and demographic characteristics and comorbidities of the patients were compared according to GFR < or > 30ml/min/m2. Results Of the 1,716 patients, 11.1% had a GFR<30 and 88.9% >30 mL/min/m2. Figure 1 shows the main clinical characteristics and comorbidities of the 2 groups. Median LVEF was similar in both groups: 42 (30-58) vs 38% (29-54). The group with advanced CKD was older (77±9.6 vs 70.5±12.6 years; p<0.001), had greater HF severity (more admissions for HF in the last year, worse NYHA functional class and longer evolution time), and a higher prevalence of coronary heart disease, hypertension, diabetes mellitus, cognitive impairment, anemia, iron deficiency and hyponatremia. There were no differences in sex, BMI, serum potassium or other comorbidities (Figure 1). Figure 2 shows the treatment received in each group. Patients with GFR <30 received in a significantly lower proportion all drugs for HF (p<0.001), except diuretics and potassium binders (ACEI/ARA, sacubitril-valsartan, MRA, beta-blockers, digoxin and SLGT2 inhibitors), and less cardiac rehabilitation (5.2 vs 10.4%; p=0.029). Incidence of one-year mortality was significantly higher in patients with GFR<30 ml/min/m2 (37.2 vs 14.4 per 100 persons-year, p<0.001), as were HF hospitalizations (61.3 vs 33.0; p<0.001) and HF decompensations without hospitalization (24.1 vs 11; p<0.001). Conclusions In our contemporary cohort of real-life HF patients, the prevalence of advanced CKD was 11.1%. These patients had a higher severity of HF, despite which, the utilization of HF drugs, including SGLT2 inhibitors was much lower than in those with GFR >30 ml/min/m2. One-year mortality, HF hospitalization and HF decompensations were almost 3-times higher. This treatment trend needs to be modified to improve the prognosis of these patients.

Factors Impacting Perceptions of Gender Inequality in the Spanish Society

This study uses Ordinary Least Squares Multiple Regression with data on perceptions regarding gender equality from the Spanish general population. Overall, the results indicate that perceptions of equal treatment under the law and equality in political life are significantly associated with perceptions of gender equality. However, perceptions of discrimination in education do not seem to affect perceptions of gender equality significantly. In addition, the results show a clear association between the belief that gender equality leads to a fairer society and the perception of gender equality itself. Results also suggest that while certain perceptions related to the law, society, and political life are instrumental in shaping views on gender inequality, there remains a foundational level of perceived inequality in Spanish society. As a concluding remark, when examining the impact of female representation in leadership positions, the results provide empirical support that the presence of women in leadership positions improves the perception of gender equity in the contexts in which it occurs; this fact reflects the importance of promoting the participation of women in management positions through public policies.

18F-FDG-PET/CT Scan for Detection of Large Vessel Involvement in Giant Cell Arteritis: Arteser Spanish Registry.

Background/Objectives: Imaging studies have transformed the diagnosis of large vessel vasculitis (LVV) involvement in giant cell arteritis (GCA). A positron emission tomography/computed tomography (PET/CT) scan with 18-fluorodeoxyglucose (18F-FDG) has emerged as a valuable tool for assessing LVV. We aimed to determine the utility of an 18F-FDG-PET/CT scan in detecting LVV in GCA in the ARTESER registry. Methods: The ARTESER study is a large multicenter, retrospective, longitudinal, and observational study, promoted by the Spanish Society of Rheumatology. It included patients newly diagnosed with GCA across 26 tertiary hospitals from 1 June 2013 to 29 March 2019. Patients with a diagnosis of incidental GCA were included if they fulfilled specific criteria, including the ACR 1990 criteria, positive imaging examinations, or the expert clinical opinion of investigators. Differences between patients with positive and negative 18F-FDG-PET/CT scan results were analyzed using a bivariate model. A regression model assessed associations in patients with a positive scan, and the predictive capacity of the cumulative dose of glucocorticoids (GC) on PET scan outcomes was evaluated using ROC curve analysis. Results: Out of 1675 GCA patients included in the registry, 377 met the inclusion criteria of having an 18F-FDG-PET/CT scan. The majority were diagnosed with a cranial GCA phenotype, and 65% had LVV. The thoracic aorta was the most frequently affected. Cardiovascular disease, diabetes, and older age had a negative association with a positive scan outcome. The OR for having a positive 18F-FDG-PET/CTC scan was lower as the number of days increased. Depending on the cumulative dosage of the GC, the 18F-FDG-PET/CT scan showed an AUC of 0.74, with a Youden index > 60 mg/day. Conclusions: Younger patients showed a higher probability of presenting LVV as detected by the 18F-FDG-PET/CT scan. The timing of the examination and the cumulative dosage of the GC influenced the likelihood of a positive result, with earlier tests being more likely to detect inflammation.

Spanish tourist industry during the Franco’s regime through the touristic cinema (1951-1977)

Mass tourism in Spain became one of the most prosperous economic sectors in the mid-twentieth century, collaborating in the process of convergence with Europe, using the seductive power of the media, especially the cinema. A quantitative and (to a lesser extent) qualitative analysis methodology was followed. After reviewing the academic literature, the records of the National Film Library were consulted, selecting 87 films of tourist content and of national production, during the period of operation of the Ministry of Information and Tourism (1951-1977). The results have made it possible to identify the tourist segments, the cinematographic genres, the type of tourists, national or foreign, as well as the heritage elements and the services present in the tourist product of the time, visualizing the scenarios where the plots of the films are developed. The cinematography allows showing the elements that constitute the economic tourism model of Franco’s Spain, focused on towns on the Mediterranean coast, especially on the Costa del Sol. The research translates the antecedents of tourism marketing, using cinema as a means of communication that recognizes the economic transformation of Spanish society and the new image of Spain to be projected abroad.

XXXII Congress of the Spanish Society of Clinical Pharmacology, 16th - 18th October 2024, Santiago de Compostela, Spain.

XXXII Congress of the Spanish Society of Clinical Pharmacology, 16th - 18th October 2024, Santiago de Compostela, Spain.

XXXII Congress of the Spanish Society of Clinical Pharmacology, 16th - 18th October 2024, Santiago de Compostela, Spain.

XXXII Congress of the Spanish Society of Clinical Pharmacology, 16th - 18th October 2024, Santiago de Compostela, Spain.

XXXII Congress of the Spanish Society of Clinical Pharmacology, 16th - 18th October 2024, Santiago de Compostela, Spain.

XXXII Congress of the Spanish Society of Clinical Pharmacology, 16th - 18th October 2024, Santiago de Compostela, Spain.

Supplement: Proceedings of the 17th International Congress of the Spanish Society for Animal Reproduction (AERA), 17 to 19 of October 2024, Madrid, Spain.

Supplement: Proceedings of the 17th International Congress of the Spanish Society for Animal Reproduction (AERA), 17 to 19 of October 2024, Madrid, Spain.