Hospital La Luz

The particle filter for most diesels and some petrol categories is now state of the art. The worldwide population is estimated to be >250 million vehicles with filters. The nanoparticle concentration in ambient air is thus reduced in Switzerland to one third of the status of 2005 and worldwide premature deaths by traffic related ambient air is reduced by >2 million cases annually. This success story started in 1995 when SUVA, the Swiss occupation health authority, had to guarantee safety and health in the world's largest railway transalpine tunnelling system, NEAT, scheduled to be built from the year 2000. The solution was VERT certified diesel particle filters (DPFs) on all engines without any exceptions. Transfer to other applications and other countries, however, had to overcome serious resistance of industry and politics which delayed the process remarkably until filters became mandatory by the EU-legislation 2011. The decisive element was the introduction of the particle number (PN) limit for solid particles of sizes 10-500 nm in place of particulate matter (PM) mass in 1995. Many vehicles are still waiting for filters worldwide and the effect of this highly effective and cost-efficient tool on health and global warming could be more than tripled.

To provide the psychometric properties of a novel patient-reported outcomes measurement (PROM), the HPV-Know-Q questionnaire, to assess the HPV-related knowledge in adult women in Spain. After reviewing literature and interviewing women with HPV infection, instrument items and domains were developed. A draft self-administered, multiple-choice questionnaire including relevant questions about HPV infection was pilot tested for comprehension and ease of completion. Psychometric evaluation of the final HPV-Know-Q questionnaire was performed in a cross-sectional, multicenter, validation study conducted in a representative sample of women with HPV infection attending gynecology consultations in Spain. A total of 349 (153 HPV+/196 HPV-) women participated. HPV-Know-Q questionnaire had acceptable metric properties of feasibility, internal consistency and temporal stability (reliability). Construct validity was supported by analyzing item-to-item and item-to-domain correlation and know groups validity, which discriminated the knowledge on HPV of women related to their infection status, abnormal cytology, educational level and prior HPV vaccination. Concurrent validity was demonstrated with a significant correlation with other scales measuring mental and sexual functioning. The HPV-Know-Q questionnaire, a novel and innovative PROM, showed acceptable psychometric properties to evaluate the HPV knowledge in women that support its use in daily medical practice and research.

This study assessed the deficit in neuroanatomy knowledge among neurosurgical trainees in Andean Latin America and tested a novel neuroanatomy curriculum using nontraditional educational resources. A total of 132 neurosurgical trainees with up to 5 years of experience in Andean Latin America participated in a 2-day neurosurgical anatomy course covering both supratentorial and infratentorial areas. Seventy-seven participants attended in person, with 37 receiving lectures only and 40 participating in both lectures and hands-on sessions. A subgroup of each cohort was granted access to a website featuring neurosurgical anatomy video lectures in Spanish. Fifty-five additional participants had access only to the neurosurgical anatomy website resource. Participants completed neurosurgical anatomy surveys immediately and at 3-month follow-up. The scores were categorized into excellence levels (subpar, basic, advanced, and connoisseur). Forty-nine of 77 (64%) course participants showed improvement in anatomic knowledge. Participants who received hands-on training were more likely to improve their scores (35 of 40; 88%) compared with those without hands-on training (15 of 37; 41%; difference 47%, 95% CI: 28.1%-65.8%, P < .01). Among all participants with website access (n = 94), 63 (67%) improved their tier of excellence compared with 10 of 38 (26%) without website access (difference 41%, 95% CI: 23.8%-57.6%, P < .01). Continued website access was an independent predictor of success (r = 0.7, 95% CI: 0.60%-0.78%, P < .001). This study underscores the need to enhance neurosurgical education in the Andean region. Combining online resources with hands-on training holds promise in addressing neuroanatomy knowledge deficits. Tailored educational programs can mitigate educational disparities in global neurosurgery.

Objective: We aimed to provide real-world insights into the management of non-small cell lung cancer stage III (NSCLC-SIII) in Spain. Methods: The GOECP-SEOR group conducted an observational, retrospective, multicenter study in which data from patients diagnosed with NSCLC-SIII treated in Spanish radiotherapy departments (RTDs) were collected. Results: A total of 1505 NSCLC-SIII patients from 35 RTDs from 2018 to 2021 were recruited. A total of 871 patients (57.9%) received concurrent chemoradiotherapy (cCRT), and 390 patients (25.91%) received maintenance durvalumab. The immunotherapy (IT) was well tolerated, with Common Terminology Criteria for Adverse Events (CTCAE) Grade 0-2 toxicity observed in 85% of the patients (295 patients). The median overall survival (OS) was 26 months (95% CI 9.4-Not Reached NR). There was a statistically significant difference when patients were stratified by IT, with a median OS of 40 months (95% CI 22.1-NR) in the IT maintenance cohort compared with 19.4 months (95% CI 7.1-58.1) in the non-IT cohort. Differences were also noted in progression-free survival (PFS), with a median PFS of 20.8 months (95% CI 9.6-NR) in the IT cohort versus 8.4 months (95% CI 3.1-25.1) in the non-IT cohort. These differences remained significant according to the multivariate model (OS: HR 0.45 [95% CI 0.36-0.56], p < 0.001; PFS: HR 0.5 [95% CI 0.42-0.59], p < 0.001). Conclusions: The management of NSCLC-SIII patients can vary, leading to differences in treatment outcomes. The treatment of lung cancer in NSCLC-SIII patients in RTDs across Spain aligns with international guidelines and expert recommendations.

Background: Hospitalized patients on chronic inhaled therapy suffer high rates of therapeutic failure. Current approaches often overlook patient heterogeneity, treating failure as a uniform problem. We hypothesized that clinical inertia, a key driver of failure, is not a monolithic entity but is governed by specific, non-overlapping factors. Methods: In this unicentric, observational cohort study of 499 hospitalized adults on chronic inhaled therapy, we used unsupervised clustering to identify patient phenotypes. Multivariable logistic regression was used to model predictors of critical inhaler errors and three distinct forms of clinical inertia: Therapeutic Class (TCI), Device-Level (DLI), and Adherence-Related (ARI). Results: Inhaler misuse was driven by objective capability—deficient knowledge (aOR 6.03, 95% CI 2.88–12.64) and low inspiratory flow (aOR 3.11, 95% CI 1.06–9.12)—while patient-reported adherence was not a significant independent predictor. Crucially, the three forms of clinical inertia were governed by distinct, non-overlapping predictors: TCI was predicted by high therapeutic potency (aOR 7.80, 95% CI 3.65–16.64), DLI by a failure in the clinical process (lack of patient training, aOR 3.49, 95% CI 1.21–10.03), and ARI by regimen complexity (aOR 0.06, 95% CI 0.02–0.25). Post-discharge mortality (21.6% overall; 25.8% in Cluster 1 vs. 18.3% in Cluster 2) was independently predicted by objective risk factors, including older age (aOR 1.51, 95% CI 1.20–1.89) and an unassessed inspiratory flow (aOR 2.44, 95% CI 1.19–5.03). Two underlying patient phenotypes were identified—an “Unassessed/Older” (n = 225) and an “Assessed/Younger” (n = 274)—which represented distinct in-hospital care pathways but did not independently predict mortality after multivariate adjustment. Conclusions: Therapeutic failure in hospitalized patients is a predictable outcome driven by distinct, non-overlapping factors. This study deconstructs this failure by identifying the specific, actionable drivers of inhaler misuse (patient capability) and the three forms of clinical inertia (therapeutic potency, failures in the care process, and regimen complexity). These processes occur within two distinct patient phenotypes that represent different in-hospital care pathways. Our findings provide a new framework to move beyond generic interventions toward a more precise, evidence-based approach to inhaled therapy.