Specialists In Spain Research Articles

Clinical application of the UroLift® prostatic urethral lift in Spain: Consensus on the treatment of lower urinary tract symptoms associated with urinary flow obstruction and secondary to benign prostatic hyperplasia (BPH)

Benign prostatic hyperplasia (BPH) is an increasingly common pathology in the adult male. BPH increases after the age of 40-45 years, and its management consumes an enormous amount of resources. The UroLift® System is an approved technology designed to treat lower urinary tract symptoms (LUTS) secondary to BPH and is used to perform the prostatic urethral lift (PUL) procedure. Various urology specialists in Spain with experience in PUL have prepared this consensus document. Endorsed by the Spanish Urology Association, its information is based on the most recent findings. The main objective of this document is to disseminate the consensus recommendations among all professionals treating patients with LUTS/BPH. Both primary care physicians and urologists can assess and offer PUL as an effective, minimally invasive treatment.

Aplicación clínica del sistema de liberación uretral UroLift® en España: consenso sobre el tratamiento de los síntomas del tracto urinario inferior asociados a la obstrucción del flujo urinario por hiperplasia benigna de próstata

Benign prostatic hyperplasia is an increasingly common pathology in the adult male, especially after the age of 40-45 years, and its management consumes an enormous amount of resources. The UroLift® system is an approved technology designed to treat lower urinary tract symptoms secondary to benign prostatic hyperplasia and is used to perform the prostatic urethral lift procedure. Various urology specialists in Spain with experience in prostatic urethral lift have prepared this consensus document. Endorsed by the Spanish Urology Association, its information is based on the most recent findings. The main objective of this document is to disseminate the consensus recommendations among all professionals treating patients with lower urinary tract symptoms/benign prostatic hyperplasia. Both primary care physicians and urologists can assess and offer prostatic urethral lift as an effective, minimally invasive treatment.

Telemedicine as a counselling tool for nurses in Central Africa.

Compare the use and trend of a telemedicine tool for clinical advice among nurses and other Cameroonian healthcare providers and explore its feasibility and accessibility. A comparative observational descriptive study. The sample includes all telemedicine users who request advice from volunteer medical specialists in Spain on clinical cases through the telemedicine tool "diagnosis assistance" (DA). It consisted of a total of 296 Cameroonian health professionals (59% women), of whom 77 were nurses. The variables in which the trend was explored (2013-2022) were DAs entered by nurses versus other healthcare professionals, compared by primary specialty, comments and documents attached. Feasibility and accessibility were explored through an anonymous survey. There were 2527 DAs between 2013 and 2022, of which nurses introduced 68%. There is an increasing trend in the nurse/other healthcare providers ratio, with significant differences in the chi-square of the linear trend between 2015 and 2022 (χ2 = 395.05; df = 7; p < .001). The probability that a DA was requested by nurses (PR >1) was observed in all years except for 2014, 2018 and 2019. The most tele-counselling requested by nurses was in the specialties of internal medicine, obstetrics and gynaecology, and dermatology. The exchange of comments and attachments was mainly conducted among nurses (74.9% and 50.4%, respectively). The users surveyed considered the tool valuable for diagnosis, applicable, with limitations due to cost, Internet quality or lack of time and effective at reducing hospital referrals. Telemedicine for clinical advice has been used mostly and with increasing tendency by nurses, mainly in internal medicine, gynaecology and dermatology, being a useful and feasible resource that can contribute to improving clinical decision-making by African nurses. The study addressed the problem of the shortage of health professionals in Central Africa and the search for alternatives that facilitate decision-making in this context. Tele-counselling tools through digital platforms that put Spanish specialists in contact with health professionals in Central Africa are mostly used by nurses working in rural health centres with a growing trend in their use. The research allows us to determine that tele-counselling tools constitute a well-accepted resource, which has a positive impact in environments with a shortage of human health resources, favouring the safety of both the nursing professional, through support in decision-making, and the populations to whom they provide care, who benefit from a multidisciplinary approach to their processes. The study has adhered to STROBE guidelines. No Patient or Public Contribution.

Perioperative management of blood pressure in neurocritical patients: Consensus reached through the Delphi method

Elaboration of a consensus document to address perioperative blood pressure (BP) in neurocritical patients, made with anesthesia and resuscitation, and intensive medicine specialists in Spain, by means of a modified Delphi methodology in two rounds with a questionnaire answered by 65 panelists. Consensus was reached in 126 (74.6 %) of 169 statements, with 113 agreements (66.9 %). Consensus was obtained for the use of clevidipine, urapidil, and beta-blockers for acute hypertension in head trauma patients and for brain tumor surgery, among others. The experts considered that the existing clinical studies evaluating the optimal perioperative therapy in neurocritical patients with altered BP are insufficient and that most recommendations are based on clinical experience. Therefore, treatment must be individualized regardless of absolute BP target value and based on occurrence/absence of acute organ damage and the coexistence of other diseases.

Management of patients with chronic rhinosinusitis with nasal polyps in Spain: learnings from a nationwide survey of otorhinolaryngologists.

To describe the self-reported practices on the diagnosis, treatment, and follow-up of patients with chronic rhinosinusitis with nasal polyps (CRSwNP) by ear, nose, and throat (ENT) specialists in Spain to identify potential areas for management optimization. A cross-sectional online survey with 16 questions was carriedout. Recruitment was performed by emailing registered ENT specialists in the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC). In total, 127 ENT specialists completed the survey. Fifty-one percent of respondents combined clinical criteria and objective evidence of mucosal inflammation to diagnose CRSwNP. Patient interview and, to a lower degree, a visual analogue scale were the most employed diagnostic tools to quantify symptom severity. Less than half (45%) routinely used the 22-item sino-nasal outcomes test (SNOT-22) to assess the impact of CRSwNP disease in quality of life. The use of patient-reported outcomes and other clinical evaluation tools showed a larger uptake among ENT specialists that worked at an ENT department with an available rhinology unit. Almost all the specialists surveyed (95%) recommended biological treatment, particularly in patients with uncontrolled CRSwNP with respiratory comorbidities (76%), as well as in candidates for revision surgery (66%). Spanish otorhinolaryngologists showed a trend toward incorporating CRSwNP guideline recommendations in their clinical practice. The observed low uptake of patient-reported outcomes and objective clinical evaluation tools in routine clinical practise have been identified as areas for optimizing the management of patients with CRSwNP.

P-680 Management of LH/FSH deficiency among assisted reproduction specialists in Spain: a Delphi consensus

Abstract Study question The objective of the study is to establish a consensus on the management of LH/FSH deficiency in assisted reproduction in Spain Summary answer It is important to consider the diverse factors that can lead to a LH/FSH deficiency in order to optimize its management and improve reproductive outcomes. What is known already Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) deficiency decrease women fertility, due to the compromised gametogenesis and steroidogenesis. Within the context of fertility and medically assisted reproduction (MAR), there are several factors (such as age, polymorphisms in gonadotropins and their receptors, and the use of gonadotrophin-releasing hormone analogue protocols) that might lead to hypo-response to ovarian stimulation and function. Therefore, the International Committee for Monitoring Assisted Reproduction Technologies (ICMART) has highlighted the importance of the action of the gonadotropin in determining LH/FSH deficiency. Study design, size, duration An online, two-round Delphi consensus comprising a 21-statement questionnaire was conducted from December 2021 to January 2022. Participants/materials, setting, methods The questionnaire included 21 statements concerning the action of LH/FSH in altered physiological conditions, the clinical presentation of LH/FSH deficiency and its importance in assisted reproduction. For each statement, a consensus was established if 70% was reached. The questionnaire was initially sent via email to 78 gynaecologists experts in assisted reproduction. Main results and the role of chance Responses from 45 and 42 assisted reproduction Spanish experts were collected in the first and second round, respectively. Overall, consensus was reached in 10 out of 21 statements (&amp;lt;50% of the statements), being two of the statements a consensus in the disagreement. Among other statements, participants agreed on: the use of long-term previous contraceptives can increase the risk of hypo-response in patients with associated risk factors regarding clinical features of LH/FSH deficiency (77.8%) and the use of POSEIDON classification in order to individualize the treatment of poor prognosis patients (71.4%). The statement that described the fact of considering baseline LH serum levels before stimulation and the consideration that LH levels should be monitored along the stimulation cycle reached a consensus in the disagreement with 82.2% and 76.2% respectively. Limitations, reasons for caution The diversity in the level of agreement of some statements should be further investigated. Wider implications of the findings It is important to consider the diverse factors that can lead to a LH/FSH deficiency in order to optimize its management and achieve an improvement in reproductive outcomes. Additionally, the diverse level of agreement of some statements should be further investigated and might reflect the variability of MAR clinical practice. Trial registration number not applicable

Survey of glaucoma surgical preferences among glaucoma specialists in Spain.

To evaluate the spectrum of glaucoma surgery undertaken among members of the Spanish Glaucoma Society (SEG). A 10 question web-based anonimous survey was mailed through the Annals of the Spanish Glaucoma Society to all its members on January, February and July 2019 to determine their preferred surgical approach. Age, type of Glaucoma, surgery undertaken, type of anti-scarring strategy and prothesis introduced for the last 10 surgeries since the survey was received. The surgeon experience was registered in years of practice. A total of 97 SEG members across the country answered the survey. Sixty-two (63.4%) responders had more than 10 years of experience. Primary open angle glaucoma was the most frequent type of glaucoma (60.6%). The most popular surgery was deep-sclerectomy (37.3%) followed by trabeculectomy (17,6%) and the collagen microshunt (XEN® Allergan Inc., Irvine, CA) (14.1%). Glaucoma drainage device (GDD) was used in 10.5% of the cases. Up to 21.7% of surgeries were reinterventions, where GDD was used in 27.3% and trabeculectomy in 20.3% of the cases. Glaucoma surgery was combined with phacoemulsification in 47.3% of the eyes. Mitomycin C (MMC) was used in 54,8% of the cases, collagen matrix (Ologen®, Aeon Astron Corporation, Taipei, Taiwan) was used alone in 8.2% of the cases and in 13,7% combined with MMC. MMC was used in a soaked sponge in 79% of cases (concentrations of 0.02% in 99% and 0.04% in 1%) and in 21% of cases MMC was injected subconjunctivally (concentrations of 0,01% in 81% and 0.02% in 19%). Although the glaucoma surgeon performs a wide range of surgical techniques, deep sclerectomy remains the most widely used surgical technique in Spain. Combined cataract and glaucoma surgery is performed almost in half of the patients and MMC is the most frequently selected antifibrotic agent, alone or combined with collagen matrix. The new minimal invasive surgical techniques represent the 20% of the total.

Forever Ramón Viladot

Dear colleagues and friends of the Latin American Foot and Ankle world, it is for me an honor and at the same time a great sadness to pass along the sad news that January brought to all of us. Ramón Viladot-Pericé, world reference in Foot and Ankle and professor of generations of specialists in Spain and Latin America, passed away in Barcelona. Providence wanted that, in the last months and even years, we had been united by an intense research activity, and I have the honor of having published with him his last scientific article, published last year in this scientific journal.What can we say… we have plenty of reasons to highlight his impressive scientific legacy and even more reasons to stress his unmeasurable human qualities. His absence leaves an enormous void impossible to fill. From the scientific point of view, his last moments were filled with an unprecedented resurgence of science in all senses: it was not time to end a project to start another, and the hours and days were not enough to meet his goals. Perhaps he never thought of such a hastyend, but even so, destiny prepared him to say goodbye in the best way: communicating how much he knew about Foot and Ankle. Among many other things, I am left with the calls of the last months, full of affection and cognizance of the perfection of his work, but also with his inexhaustible eagerness for rigorous scientific production. With Ramón Viladot part of the History of Foot and Ankle is gone. Probably nothing will be the same from now on, but we are left withhis unequaled personal and scientific legacy, his disposition, his human qualities. Surely many of the readers of this Editorial can identify with these words, as there are many of us who have shared operations and consultations with him both at the Hospital San Rafael and at the Clínica Tres Torres in Barcelona.The person died, but the memory lives on. As writer Mario Benedetti said:“If I live in your memory, I will not be alone.”We will all certainly remember him forever. Forever Ramón...

Identifying and preventing burnout in young oncologists, an overwhelming challenge in the COVID-19 era: a study of the Spanish Society of Medical Oncology (SEOM)

BackgroundYoung oncologists are at particular risk of professional burnout, and this could have a significant impact on their health and care of their patients. The coronavirus disease 2019 (COVID-19) pandemic has forced rapid changes in professionals' jobs and training, with the consequent physical and psychological effects. We aimed to characterize burnout levels and determinants in young oncologists, and the effects of the pandemic on their training and health.MethodsTwo online surveys were conducted among oncology residents and young oncology specialists in Spain. The first addressed professional burnout and its determinants before the COVID-19 pandemic, while the second analyzed the impact of the pandemic on health care organization, training, and physical and psychological health in the same population.ResultsIn total, 243 respondents completed the first survey, and 263 the second; 25.1% reported significant levels of professional burnout. Burnout was more common among medical oncology residents (28.2%), mainly in their second year of training. It was significantly associated with a poor work–life balance, inadequate vacation time, and the burnout score. Nearly three-quarters of respondents (72%) were reassigned to COVID-19 care and 84.3% of residents missed part of their training rotations. Overall, 17.2% of this population reported that they had contracted COVID-19, 37.3% had scores indicating anxiety, and 30.4% moderate to severe depression. Almost a quarter of young oncologists (23.3%) had doubts about their medical vocation.ConclusionsBurnout affects a considerable number of young oncologists. The COVID-19 pandemic has had a profound impact on causes of burnout, making it even more necessary to periodically monitor it to define appropriate detection and prevention strategies.

National digestive disease specialists survey on cardiovascular risk management in non-alcoholic fatty liver disease in spanish hospitals.

Cardiovascular disease (CVD) is the main cause of mortality among non-alcoholic fatty liver disease (NAFLD) patients. The aim was to explore the level of knowledge and clinical management of cardiovascular risk (CVR) in NAFLD patients by Digestive Disease specialists. An anonymous web-based survey was designed with 44 close-ended questions, divided into five sections, that were based on current guidelines on CVD prevention. Between November 2019 and January 2020, Digestive Disease specialists from Spanish hospitals were invited to participate in this survey via email and Twitter. Student's t, chi-square and Fishers' exact tests, and logistic regression were used for data analysis. 208 clinicians completed the survey. Most respondents (83.2%) believe that NAFLD is an independent risk factor for CVD, especially in the presence of NASH and fibrosis. Personal history of CVDs and cardiovascular risk-related comorbidities are collected by more than 75% of respondents. However, less than 17% perform an elementary physical examination to address the CVR, except weight which is evaluated by 69.8%. Over 54% of respondents do not perform or request any supplementary tests for CVR assessment, and only 10.2% use specific calculators. Furthermore, 54.3% spend less than 5minutes giving lifestyle advice, and more than 52% do not start drug treatment after a recent diagnosis of any cardiovascular comorbidity. Only 25.6% have a multidisciplinary Unit for metabolic comorbidities in their hospitals, although 89% of the respondents would support the implementation of this Unit. Cardiovascular risk management in daily clinical practice by Digestive Disease specialists in Spain remains suboptimal.

Massive impact of coronavirus disease 2019 pandemic on gastroenterology and hepatology departments and doctors in Spain.

Significant human and material resources have been diverted to coronavirus disease 2019 (COVID-19). Healthcare workers are at high risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We assess the impact of the COVID-19 pandemic on gastroenterology and hepatology departments and specialists in Spain. This study involves a nationwide survey addressing the impact of COVID-19 on resources, procedures, and physicians of gastroenterology and hepatology departments in 81 hospitals representative of the Spanish National Health Service. Overall, 41.8% of hospital beds and 40.7% of gastroenterology and hepatology beds were allocated to COVID-19 patient care, as well as 24.8% of gastroenterologists and 58.3% of residents. Outpatient visits, abdominal ultrasounds, and endoscopies were reduced by 81.8-91.9%. Nine large university hospitals had 75% and 89% reductions in therapeutic endoscopies and hepatocellular carcinoma surgery, respectively, with cancelation of elective liver transplant and transjugular intrahepatic portosystemic shunt. Prevalence of infected physicians was 10.6% and was dependent on regional population incidence (r=0.74, P=0.001), with 11% hospitalized and one physician dying. Up to 63.4% of physicians may have been infected before or shortly after Spain entered lockdown, 57% of them having recently performed endoscopies. Adequate protection was acknowledged in >80% hospitals, but only 2.9% performed regular SARS-CoV-2 testing. The impact of the COVID-19 pandemic on healthcare delivery has been massive. A wave of gastroenterology-related complications is expected because of resource diversion. Gastroenterologists have a high prevalence of infection, although they may have been infected during a first phase of lower awareness and protection. Regular SARS-CoV-2 screening, adequate protection, and quick reorganization of healthcare resources are still needed.

Estudio sobre las competencias profesionales de Enfermería del Trabajo en España

To evaluate the importance and degree of development of the professional competences of occupational health nursing specialists in Spain described in Public Order SAS/1348/2009 in the areas of prevention, clinical care services, legal expertise, management, teaching and research. This cross-sectional, descriptive study surveyed occupational health nurse members of specific and/or relevant multidisciplinary professional societies at the autonomous community or state levels in Spain. A questionnaire, designed by an expert panel and centered on approved professional competencies was administered in 2014. Descriptive statistics summarized the sociodemographic profile of respondents. Bivariate analysis, followed by multivariate linear regression analysis, was used to measure associations between specific independent variables and both the perceived importance and degree of development of each competency. In the descriptive analysis of perceived importance, there are three competencies that stand out: manage a registration system that ensures the confidentiality of the data; increase the health level of the worker through health promotion and risk prevention, and identify real or potential occupational health problems. Regarding highest degree of development, the following stand out: management of a confidentiality registration system; provide urgent and emergency care in the workplace and identify real or potential occupational health problems. Type of occupational health service, the economic sector to which the company belonged and years of professional experience were associated with both the importance and degree of development of each of the competencies.

Management of Wet Age-Related Macular Degeneration in Spain: Challenges for Treat and Extend Implementation in Routine Clinical Practice.

Purpose To ascertain wet AMD (wAMD) management patterns in Spain. Methods A two-round Delphi study conducted through a questionnaire-based survey designed from literature review and validated by an independent Steering Committee. Results Forty-nine retina specialists experienced in wAMD participated by answering the two-round study questionnaire. Retina specialists are the main responsible for wAMD diagnosis and monitoring, including visits and associated procedures, with a median time per visit of 15 minutes. Standard treatment strategies are based on anti-VEGF administration, including standard loading dose administration followed by maintenance with aflibercept or ranibizumab (81% of patients). Although treat and extend (T&E) dosing strategy is considered as optimal for wAMD management (78% of the panelists), the main routine healthcare limitations (i.e., visits overload, reduced staff, short visit time, coordination issues, lack of facilities) conduct to self-defined “flexible” strategies, based on T&E and pro-re-nata (PRN) protocols. Conclusion Proactive treatment patterns (T&E) are the preferred ones by the retina specialists in Spain. However, their proper implementation is difficult due to healthcare resource limitations, as well as organisation and logistic issues. The use of anti-VEGF agents with longer duration of action could facilitate the use of strict T&E approaches according to routine clinical practices.

Survey on the Knowledge of Cochlear Implant Indication in the Treatment of Hearing Loss in Spain

IntroductionThis study aims to analyse the knowledge of cochlear implant (CI) candidacy criteria of otorhinolaryngology specialists in Spain, and from the results, consider whether it is necessary to implement training measures aimed at improving knowledge in this area. Material and methodsA questionnaire was designed for measuring the level of knowledge of cochlear implant candidacy criteria (CI) in people with hearing loss. The questionnaire collected the demographic data of the respondents and their knowledge on the conventional and emergency indications for CI, technical characteristics of CI and results in the implanted population. ResultsA total of 222 Spanish specialists in otorhinolaryngology answered the questionnaire (10.29% of the sample surveyed). ConclusionsThe 50% of all respondents showed a medium-high knowledge about CI. Epidemiological data suggest that a high percentage of adults with postlocutive deafness and candidates for a CI are not referred for treatment. The lack of knowledge about the criteria for the indication of CI by otorhinolaryngology specialists may contribute to inadequate guidance of patients who are potential candidates for CI. The greatest shortcomings are found in the most emergency indications for a CI. Among otorhinolaryngology professionals, the greatest knowledge about CI is found in those who work in tertiary hospitals in the areas of otology and otoneurology, either in the public or private sector. This study suggests that training on CI should be increased for otorhinolaryngology professionals, especially for general otorhinolaryngologists.

Introduction II: William C. Atkinson (1902–1992) Scholar of Spain, Portugal and Latin America

In ‘Introduction II. William C. Atkinson (1902–1992): Scholar of Spain, Portugal and Latin America’, Ann L. Mackenzie conducts a detailed survey of William Atkinson’s life and career, from his beginnings in Belfast, Northern Ireland through to his death, aged ninety, in 1992. Mackenzie’s survey is derived mainly from first-hand research into Atkinson’s memoirs and scholarly publications; she has also utilized obituaries, reviews and documentary evidence preserved in the archives at Queen’s University Belfast, where he obtained his degrees, and at Glasgow University where he was Stevenson Professor of Hispanic Studies (1932–1972). Among his many services to Hispanism, Mackenzie highlights his pioneering role in establishing Portuguese Studies and, especially, Latin American Studies, as principal fields of learning in British universities. He is also remembered for taking over the editorship of the Bulletin of Spanish Studies when its founder-editor E. Allison Peers died in 1952, thereby ensuring its survival. Mackenzie assesses in detail Atkinson’s numerous scholarly publications—not only his books, editions and translations, but also his articles and reviews in major journals. His most influential works, in her view, were his biographical and critical study of the sixteenth-century Spanish Humanist, Hernán Pérez de Oliva, his History of Spain and Portugal and his prose-translation of Camões’ The Lusiads. Among his most memorable activities were the five lengthy visits he made to Latin America between 1946 and 1971: these lecture tours mostly funded by the British Council, took him to all twenty Latin-American countries several times over. Mackenzie also records what he did during World War II, when he was seconded to the Foreign Office. Though based mainly at Oxford, he was sent on several fact-finding missions to Spain and Portugal. Mackenzie also writes about Atkinson in situ at Glasgow University where as Professor and Head of Hispanic Studies, and latterly also as Director of the Latin-American Institute (established in 1966), he showed an exemplary interest in the welfare of his students, and in assisting them to pursue careers in banking, commerce, school-teaching, the Civil Service and, especially, Higher Education. Many of his graduates took up lectureships and professorships in universities, both at home and overseas, where they trained more academics in their turn, as specialists in Spain, Portugal and Latin America.

Budget Impact Analysis of Supra-Ciliary Microstent Device Utilization In Primary open Angle Glaucoma Patients In A Spanish Hospital Outpatient Setting

Minimally Invasive Glaucoma Surgery (MIGS) devices fill an unmet need in therapy between topical pharmacological medicines and more invasive filtration procedures. This study evaluates the budget impact of using a new supra-ciliary microstent (Alcon Laboratories) device in Spanish hospitals as a stand-alone procedure or in conjunction with cataract surgery primary open angle glaucoma (POAG) patients where previous treatments have failed. A budget impact model (BIM) from a Spanish hospital outpatient perspective was developed using Microsoft® Excel®. Population and cost estimates were derived from published sources. POAG disease characteristics were obtained from the literature and an online survey of 40 practicing glaucoma/cataract specialists in Spain. Comparators and market share data were obtained from independent market research. Resource use assumptions associated with each intervention were obtained through survey results and from interviews with four key opinion leaders. Costs included published device costs, post-procedure follow-up care, and facility costs. An estimated 227,248 trabeculectomy, laser assisted trabeculoplasty or MIGS POAG interventions will occur over five years, 21,452 of which will use supra-ciliary microstent. The use of supra-ciliary microstent will have a low budget impact of 5.3% in the first year (€1,116,370) and an average budget impact of 8.2% over five years, with cost increases primarily driven by patients shifting from lower cost laser trabeculoplasty procedures. However, total intervention costs for supra-ciliary microstent (€1774) are lower than total intervention costs for the other included MIGS procedures (trabecular micro-bypass generation 1: €1829; subconjunctival gelatin stent: €2744) and similar to the common, but invasive trabeculectomy surgery (€1762). MS cost offsets were driven by decreases in procedure-related resource use and post-procedure follow-up care. Univariate sensitivity analyses confirm that model results are robust. The introduction of supra-ciliary microstent will have a minimal budget impact in Spain while increasing access to a valuable, minimally invasive treatment alternative for glaucoma.

Encuesta sobre el conocimiento en la indicación de implantes cocleares para el tratamiento de la hipoacusia en España

IntroductionThis study aims to analyse the knowledge of cochlear implant (CI) candidacy criteria of otorhinolaryngology specialists in Spain, and from the results, consider whether it is necessary to implement training measures aimed at improving knowledge in this area. Material and methodsA questionnaire was designed for measuring the level of knowledge of cochlear implant candidacy criteria (CI) in people with hearing loss. The questionnaire collected the demographic data of the respondents and their knowledge on the conventional and emergency indications for CI, technical characteristics of CI and results in the implanted population. ResultsA total of 222 Spanish specialists in otorhinolaryngology answered the questionnaire (10.29% of the sample surveyed). ConclusionsThe 50% of all respondents showed a medium-high knowledge about CI. Epidemiological data suggest that a high percentage of adults with postlocutive deafness and candidates for a CI are not referred for treatment. The lack of knowledge about the criteria for the indication of CI by otorhinolaryngology specialists may contribute to inadequate guidance of patients who are potential candidates for CI. The greatest shortcomings are found in the most emergency indications for a CI. Among otorhinolaryngology professionals, the greatest knowledge about CI is found in those who work in tertiary hospitals in the areas of otology and otoneurology, either in the public or private sector. This study suggests that training on CI should be increased for otorhinolaryngology professionals, especially for general otorhinolaryngologists.

Perception of Canine Welfare Concerns among Veterinary Students, Practitioners, and Behavior Specialists in Spain

Veterinarians are well placed to supervise and ensure canine welfare. However, the perception of animal welfare among veterinarians may vary depending on the level of training and professional practice, including the specialization in animal behavior and welfare. The aim of this study was to survey the perception of canine welfare among veterinarians, including students, practitioners, and behavior specialists. A scale-based questionnaire including 12 issues affecting canine welfare was adapted from Yeates and Main and distributed to first-year (n=50) and fifth-year veterinary students (n=50), as well as veterinary practitioners (n=260) and specialists in behavioral medicine (n=50). For each issue, respondents were asked to rate how much they perceived each issue to affect canine welfare (on a scale of 0 to 4). A General Linear Model test was used to assess the effect of the studied group on scores. "Physical abuse or cruelty" was the highest-scoring problem in all groups and "breed-related conditions" was the lowest. In general, specialists in behavioral medicine assigned significantly higher scores to most items, particularly "behavioral problems" and "lack of sufficient company." In contrast, fifth-year students assigned significantly lower scores to most items. This study shows that situations clearly affecting canine welfare represent an important concern for veterinarians, both undergraduates and professionals. However, the level of professional experience and specialization might influence the perception of more subtle examples of poor welfare. Raising awareness regarding canine welfare, including concern for breed- or behavior-related problems, should be emphasized within university programs.

Diagnosis and management of breakthrough cancer pain: Have all the questions been resolved? A Delphi-based consensus assessment (DOIRON).

To ascertain the level of agreement and achieve a consensus among cancer pain specialists in Spain with regard to the optimal definition, diagnosis, and management of breakthrough cancer pain (BTcP). Two-round Delphi methodology survey (February-May 2013) using seven-point Likert scales (ranging from 1 "strongly disagree" to 7 "strongly agree") was carried out. Mean scores >5 or <3 indicated, respectively, agreement or disagreement. Scores from 3 to 5 indicated no consensus. A total of 126 experienced specialists were surveyed. Response rates were 68% in round 1 and 90% in round 2. Agreement (mean Likert score) was strongest for the proposed BTcP definition (6.6), the use of oral (6.1), and intranasal (6.0) transmucosal fentanyl, the need for early assessment after BTcP treatment initiation, and the need to improve staff knowledge of BTcP. Broad agreement was also reached regarding the need to systematically screen all cancer patients for BTcP (5.9). Most respondents (82%) considered strong opioids to be appropriate treatment. In contrast, no consensus was reached regarding strong opioid treatment for baseline pain as a prerequisite for BTcP diagnosis. Consensus was strong for most treatment, and diagnostic aspects were evaluated in the study. However, several important issues remain unresolved, particularly whether the diagnostic criteria must include strong opioids for background pain. Nurses' awareness and understanding of BTcP was considered insufficient, and more training is needed in this area. Overall, agreement among specialists was good, but more work is needed to better define the optimal diagnostic features and treatments for this condition.

The Search for the Perfect Color: Pigments, Tints, and Binders in the Scientific Expeditions to the Americas

In the eighteenth century, the Spanish Crown underwrote several expeditions in order to collect, classify, and describe the newly available natural resources in the Americas. In an attempt to convey scientific information objectively, expedition artists had to depict their specimens with absolute fidelity. Because many of them had not mastered the techniques necessary for botanical illustration, despite their formal training, Jose Celestino Mutis created a school for local artists in the New Kingdom of Granada (present day Colombia). Pigments and dyes that artists could not obtain from Spain or from the major cities in the New World through which they passed were often derived from experimentation with local materials.