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Study Objective: To determine the incidence of chronic postsurgical pain (CPSP) in women after open thoracotomy. Secondary objectives were to compare relevant patient and procedural variables between women and men. Design: Observational cohort study. Setting: Ten university-affiliated hospitals. Subjects: Ninety-six women and 137 men. Interventions: Scheduled open thoracotomy. Measurements: Pain histories, psychological measures, and perceived health status and catastrophizing scores were obtained. The diagnosis of chronic postsurgical pain was by physical examination at 4 months. Standard preoperative, intraoperative, and postoperative data were also recorded. Main Results: The chronic postsurgical pain incidence was significantly higher in women (53.1%) than in men (38.0%) (p = 0.023). At baseline, women had significantly worse scores on psychological measures (perception of mental state [p = 0.01], depression [p = 0.006], and catastrophizing [p < 0.001]). Women also reported more preoperative pain in the operative area (p = 0.011) and other areas (p = 0.030). Conclusion: These findings show that the incidence of physician-diagnosed chronic postsurgical pain is higher in women than in men after surgeries involving thoracotomy. Sex and gender should be included in future clinical research on pain in surgical settings.
(2024) Roca, Gisela; Sabaté, Sergi; Serrano, Ancor; Benito M.C.; Perez M.; Revuelta M.; Lorenzo A.; Busquets J.; Rodriguez G.; Sanz D.; Jimenez A.; Parera A.; de la Gala F.; Montes A.Este trabajo presenta una propuesta para la evaluación integral de la calidad de un sitio web turístico. En él se aborda el estado de la cuestión sobre la calidad web, tanto en general como en el contexto especializado del turismo. Tiene como objetivo demostrar que la calidad de un sitio web turístico no puede ser evaluada utilizando un único sistema de análisis, procedimiento seguido y propuesto habitualmente tanto por la industria como por la academia. Tomando en consideración el sitio web oficial de la ciudad de Barcelona, esta investigación demuestra que para la evaluación integral de su calidad es necesario utilizar dos sistemas de análisis: uno de ellos centrado en los aspectos estratégicos del sitio web y otro focalizado en sus aspectos técnicos. Con el fin de validar esta hipótesis se han utilizado dos sistemas de análisis actualmente en uso: el sistema SAST (para la evaluación técnica del sitio) y el sistema WSCM (para su evaluación estratégica).
Los resultados alcanzados tras la aplicación de ambos sistemas demuestran que su utilización conjunta e interrelacionada ofrece una evaluación completa y precisa del sitio web. Además, se constata que la utilización individual de un único sistema podría propiciar una evaluación parcial e inexacta del sitio web.
(2019) Sanabre, Carles
; Vinyals Mirabent, Sara; Pedraza, Rafael
Purpose: To generate an evaluation checklist for the multidisciplinary approach to patients with asthma or suspected asthma. Patients and methods: This was a qualitative study based on a literature review and expert opinions. A multidisciplinary steering committee with knowledge and experience in asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) was established and comprised two pneumologists, two allergologists, and two otorhinolaryngologists. They designed a preliminary evaluation checklist based on the best evidence available and their experience. An extra panel of 21 experts (five pneumologists, five allergologists, and 11 otorhinolaryngologists) analyzed and discussed the checklist, leading to the final version. Results: The checklist for the multidisciplinary approach to patients with asthma or suspected asthma includes the first and the follow-up visits. It is organized into several sections covering 1) current asthma and past history (diagnosis, symptoms, severity, control, etc.); 2) comorbidities (CRSwNP, atopic dermatitis, etc.); 3) physical examination and diagnostic tests (spirometry, bronchodilator reversibility test, fractional exhaled nitric oxide, etc.); 4) complementary tests (imaging, laboratory, allergy tests, etc.); 5) red flags (near-fatal asthma, CRSwNP complications); and 6) biological treatment (indication, response to treatment, decision making, etc.). Each section is divided into sub-sections detailing the recommended evaluation items. These items contain explanations, definitions, or variable lists that can be measured using direct questions, validated questionnaires, or other procedures such as imaging techniques or biomarkers. The checklist also proposes clinical actions. Conclusion: This evaluation checklist might help improve and standardize the clinical management of patients with asthma or suspected asthma.
(2024) Almonacid, Carlos; Ausín Herrero, Pilar, 1974-; Villacampa, José Miguel; Dávila, Ignacio; Pinilla, Mayte; Dominguez-Ortega, JavierBackground: Whether improvements in cardiovascular health (CVH) in midlife mitigate cardiovascular disease (CVD) risk in patients with diabetes remains underexplored. Objectives: The aim of the study was to examine the relationships between changes in CVH during midlife and subsequent risks of CVD events and all-cause mortality among individuals with and without diabetes. Methods: The study utilized data from the Atherosclerosis Risk in Communities Study. CVH data were collected during visits 1 and 3 and the median follow-up was 23 years. CVH was based on ideal Life's Simple 7 metrics and categorized as low (0-2 metrics), moderate (3 or 4 metrics), and favorable CVH (5-7 metrics). Cox proportional hazards regression models were used to determine the association between changes in CVH and CVD outcomes. Results: Among the final sample (N = 8,741), 806 had diabetes (9.2%). Of those with diabetes, 62.3% had low CVH at both visits, 12.0% maintained moderate CVH, 15.0% showed improvement, and 10.3% experienced a decline in CVH. Only 0.4% maintained favorable CVH. Those with improved CVH had lower CVD event risks (HR: 0.69; 95% CI: 0.50-0.93), as did those who maintained moderate CVH (HR: 0.68; 95% CI: 0.50-0.94) or shifted from moderate to low CVH (HR: 0.60; 95% CI: 0.41-0.88). Similar patterns were observed for all-cause mortality. In comparison to participants without diabetes who maintained a favorable CVH trajectory at midlife, those with diabetes consistently displayed higher risks of CVD events and mortality, regardless of their CVH trajectory. Conclusions: For patients with diabetes, achieving or maintaining ideal CVH levels at midlife may help improve outcome; however, CVD risk is not completely mitigated by favorable CVH trajectories.
(2024) Sattler, Elisabeth L. P.; Lassale, Camille; Diaw, Mor; Joseph, Joshua J.; Singh, Gurbinder; Samb, Abdoulaye; Lloyd-Jones, Donald M.; Gaye, Bamba