Hospital del Mar Research Institutehttp://hdl.handle.net/10230/231152024-03-29T10:45:42Z2024-03-29T10:45:42ZManagement of paraesophageal hiatus hernia: recommendations following a European expert Delphi consensusGerdes, StephanSchoppmann, Sebastian F.Bonavina, LuigiBoyle, NicholasMüller-Stich, Beat P.Gutschow, Christian A.Hiatus Hernia Delphi Collaborative Grouphttp://hdl.handle.net/10230/596012024-03-28T02:30:32Z2023-01-01T00:00:00ZManagement of paraesophageal hiatus hernia: recommendations following a European expert Delphi consensus
Gerdes, Stephan; Schoppmann, Sebastian F.; Bonavina, Luigi; Boyle, Nicholas; Müller-Stich, Beat P.; Gutschow, Christian A.; Hiatus Hernia Delphi Collaborative Group
Aims: There is considerable controversy regarding optimal management of patients with paraesophageal hiatus hernia (pHH). This survey aims at identifying recommended strategies for work-up, surgical therapy, and postoperative follow-up using Delphi methodology. Methods: We conducted a 2-round, 33-question, web-based Delphi survey on perioperative management (preoperative work-up, surgical procedure and follow-up) of non-revisional, elective pHH among European surgeons with expertise in upper-GI. Responses were graded on a 5-point Likert scale and analyzed using descriptive statistics. Items from the questionnaire were defined as "recommended" or "discouraged" if positive or negative concordance among participants was > 75%. Items with lower concordance levels were labelled "acceptable" (neither recommended nor discouraged). Results: Seventy-two surgeons with a median (IQR) experience of 23 (14-30) years from 17 European countries participated (response rate 60%). The annual median (IQR) individual and institutional caseload was 25 (15-36) and 40 (28-60) pHH-surgeries, respectively. After Delphi round 2, "recommended" strategies were defined for preoperative work-up (endoscopy), indication for surgery (typical symptoms and/or chronic anemia), surgical dissection (hernia sac dissection and resection, preservation of the vagal nerves, crural fascia and pleura, resection of retrocardial lipoma) and reconstruction (posterior crurorrhaphy with single stitches, lower esophageal sphincter augmentation (Nissen or Toupet), and postoperative follow-up (contrast radiography). In addition, we identified "discouraged" strategies for preoperative work-up (endosonography), and surgical reconstruction (crurorrhaphy with running sutures, tension-free hiatus repair with mesh only). In contrast, many items from the questionnaire including most details of mesh augmentation (indication, material, shape, placement, and fixation technique) were "acceptable". Conclusions: This multinational European Delphi survey represents the first expert-led process to identify recommended strategies for the management of pHH. Our work may be useful in clinical practice to guide the diagnostic process, increase procedural consistency and standardization, and to foster collaborative research.
2023-01-01T00:00:00ZThe impact of mutational clonality in predicting the response to immune checkpoint inhibitors in advanced urothelial cancerBoll, Lilian MariePerera Bel, JúliaRodriguez-Vida, AlejoArpí Llucià, OriolRovira, AnaJuanpere, NuriaVázquez Montes de Oca, SergioHernández Llodrà, SilviaLloreta Trull, Josep, 1958-Albà Soler, MarBellmunt Molins, Joaquim, 1959-http://hdl.handle.net/10230/596002024-03-28T02:30:34Z2023-01-01T00:00:00ZThe impact of mutational clonality in predicting the response to immune checkpoint inhibitors in advanced urothelial cancer
Boll, Lilian Marie; Perera Bel, Júlia; Rodriguez-Vida, Alejo; Arpí Llucià, Oriol; Rovira, Ana; Juanpere, Nuria; Vázquez Montes de Oca, Sergio; Hernández Llodrà, Silvia; Lloreta Trull, Josep, 1958-; Albà Soler, Mar; Bellmunt Molins, Joaquim, 1959-
Immune checkpoint inhibitors (ICI) have revolutionized cancer treatment and can result in complete remissions even at advanced stages of the disease. However, only a small fraction of patients respond to the treatment. To better understand which factors drive clinical benefit, we have generated whole exome and RNA sequencing data from 27 advanced urothelial carcinoma patients treated with anti-PD-(L)1 monoclonal antibodies. We assessed the influence on the response of non-synonymous mutations (tumor mutational burden or TMB), clonal and subclonal mutations, neoantigen load and various gene expression markers. We found that although TMB is significantly associated with response, this effect can be mostly explained by clonal mutations, present in all cancer cells. This trend was validated in an additional cohort. Additionally, we found that responders with few clonal mutations had abnormally high levels of T and B cell immune markers, suggesting that a high immune cell infiltration signature could be a better predictive biomarker for this subset of patients. Our results support the idea that highly clonal cancers are more likely to respond to ICI and suggest that non-additive effects of different signatures should be considered for predictive models.
2023-01-01T00:00:00ZAdherence to inhaled corticosteroids in patients with asthma prior to and during the COVID-19 pandemicRodríguez, IsabelLópez-Caro, Juan CarlosGonzález-Carranza, SilviaCerrato, Maria ElenaPrado, Maria del Mar deGómez-Molleda, FranciscaPinel, MargaritaSaiz, Maria TeresaFuentes, CarmenBarreiro Portela, EstherSantibáñez, Miguelhttp://hdl.handle.net/10230/595932024-03-28T02:30:41Z2023-01-01T00:00:00ZAdherence to inhaled corticosteroids in patients with asthma prior to and during the COVID-19 pandemic
Rodríguez, Isabel; López-Caro, Juan Carlos; González-Carranza, Silvia; Cerrato, Maria Elena; Prado, Maria del Mar de; Gómez-Molleda, Francisca; Pinel, Margarita; Saiz, Maria Teresa; Fuentes, Carmen; Barreiro Portela, Esther; Santibáñez, Miguel
The electronic prescription refill rate (EPRR) of 183 consecutive patients was determined over a 19-month retrospective study period, divided into 7 months PRE (Sep-19 to Mar-20) and 12 months POST pandemic (Apr-20 to Mar-21), in order to compare adherence to inhaled corticosteroids (ICS) in patients with asthma prior to and during the COVID-19 pandemic. Before the pandemic (PRE), an average of 0.58 inhalers/month were refill from the pharmacy; [SD 0.33], very similar to the 0.59 inhalers/month; [SD 0.34] retrieved during the 12 subsequent months since the pandemic (POST) (p = 0.768). EPRR showed no differences (p = 0.784). When EPRR was dichotomous or ordinal categorised no differences were found either (p = 0.851 and 0.928), even when McNemar's test was used (p = 0.949), with prevalences of nonadherence (EPRR < 80%) of 57 and 58% respectively. Our results do not support increased adherence to inhaler treatment in terms of EPRR, comparing before and since COVID-19 pandemic. Compliance with prescription remains suboptimal.
2023-01-01T00:00:00ZAntidepressant use in low- middle- and high-income countries: a World Mental Health Surveys reportKazdin, Alan E.Alonso Caballero, JordiWHO World Mental Health Survey Collaboratorshttp://hdl.handle.net/10230/595892024-03-28T02:30:34Z2023-01-01T00:00:00ZAntidepressant use in low- middle- and high-income countries: a World Mental Health Surveys report
Kazdin, Alan E.; Alonso Caballero, Jordi; WHO World Mental Health Survey Collaborators
Background: The most common treatment for major depressive disorder (MDD) is antidepressant medication (ADM). Results are reported on frequency of ADM use, reasons for use, and perceived effectiveness of use in general population surveys across 20 countries. Methods: Face-to-face interviews with community samples totaling n = 49 919 respondents in the World Health Organization (WHO) World Mental Health (WMH) Surveys asked about ADM use anytime in the prior 12 months in conjunction with validated fully structured diagnostic interviews. Treatment questions were administered independently of diagnoses and asked of all respondents. Results: 3.1% of respondents reported ADM use within the past 12 months. In high-income countries (HICs), depression (49.2%) and anxiety (36.4%) were the most common reasons for use. In low- and middle-income countries (LMICs), depression (38.4%) and sleep problems (31.9%) were the most common reasons for use. Prevalence of use was 2-4 times as high in HICs as LMICs across all examined diagnoses. Newer ADMs were proportionally used more often in HICs than LMICs. Across all conditions, ADMs were reported as very effective by 58.8% of users and somewhat effective by an additional 28.3% of users, with both proportions higher in LMICs than HICs. Neither ADM class nor reason for use was a significant predictor of perceived effectiveness. Conclusion: ADMs are in widespread use and for a variety of conditions including but going beyond depression and anxiety. In a general population sample from multiple LMICs and HICs, ADMs were widely perceived to be either very or somewhat effective by the people who use them.
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