RESUMO
BACKGROUND AND RATIONALE: Thromboembolic complications are a serious, preventable and common event in cancer patients that contributes to increasing morbidity and mortality. Despite increasing knowledge on cancer-associated thrombosis (CAT), there are still several aspects of diagnosis, clinical management, treatment and prognosis with uncertainties that are under-represented in randomized clinical trials. For this reason, the Spanish Society of Medical Oncology (SEOM) launched in June 2018 a registry of CAT. METHODS/DESIGN: TESEO is an ongoing prospective, non-interventional, multicentric study in consecutive cancer patients with newly diagnosed of thromboembolic event (TEE). Eligibility criteria include being > 18 years with a histologically confirmed diagnosis of cancer and a symptomatic or incidental TEE confirmed with an imaging technique in the previous month or any time after the cancer diagnosis and signing of informed consent. The study consists of two types of integrated but independent prospective registries. Regular CAT sub-registry includes information on patient's cancer´s characteristics, anticoagulant treatment provided and outcome data. Special CAT sub-registry includes variables related to special situations of CAT that comprise patients with severe kidney failure, thrombocytopenia, high risk of bleeding related to the cancer or with coexistence of bleeding and patients who receive new treatments such a targeted therapy, antiangiogenics agents and immunotherapy. The registry considers the status of the cancer and the time to assess how the prognosis is changed based on when the thrombus occurs. Some outcomes such as rethrombosis, major bleeding, tumor progression and survival will be valued in various time intervals including 1, 3, 6 and 12 months after the even in the first year; and then every 6 months until the patient's death. RESULTS: After 18 months and with 35 centers and researchers, the registry has 1128 patients. CONCLUSION: TESEO registry will provide clinical real-world evidence for prevention, treatment and complications of CAT in different scenarios that are under-represented in randomized clinical trials.
Assuntos
Neoplasias/complicações , Sistema de Registros/estatística & dados numéricos , Tromboembolia/epidemiologia , Inibidores da Angiogênese/uso terapêutico , Anticoagulantes/uso terapêutico , Progressão da Doença , Hemorragia/epidemiologia , Humanos , Imunoterapia , Oncologia , Terapia de Alvo Molecular , Neoplasias/terapia , Prognóstico , Recidiva , Insuficiência Renal/epidemiologia , Sociedades Médicas , Espanha/epidemiologia , Trombocitopenia/epidemiologia , Tromboembolia/tratamento farmacológico , Tromboembolia/etiologia , Tromboembolia/prevenção & controle , Resultado do Tratamento , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologiaRESUMO
AIMS: To discuss our concern for some aspects of mathematics learning disorders related to the nomenclature employed and their diagnosis; these aspects refer to the term 'dyscalculia' and to its diagnosis (especially syndromatic diagnosis). We also intend to propose a classification that could help to define the terminology. Lastly we are going to consider the different aspects of diagnosis and to determine which of them are indispensable in the diagnosis of primary and secondary disorders. DEVELOPMENT: As far as the nomenclature is concerned, we refer to the term 'dyscalculia'. The origins of the term are analysed along with the reasons why it should not be used in children with difficulties in learning mathematics. We propose a classification and denominations for the different types that should undoubtedly be discussed. With respect to the diagnosis, several problems related to the syndromatic diagnosis are considered, since in our country there are no standardised tests with which to study performance in arithmetic and geometry. This means that criterion reference tests are conducted to try to establish current and potential performance. At this stage of the diagnosis pedagogical and psychological studies must be conducted. The important factors with regard to the topographical and aetiological diagnoses are prior knowledge, results from the studies that have been carried out and findings from imaging studies. The importance of a genetic study must be defined in the aetiological diagnosis. CONCLUSIONS: We propose a nomenclature to replace the term 'dyscalculia'. Standardised tests are needed for the diagnosis. The need to establish current and potential performance is hierarchized. With regard to the topographical diagnosis, we highlight the need for more information about geometry, and in aetiological studies the analyses must be conducted with greater numbers of children.
Assuntos
Deficiências da Aprendizagem/diagnóstico , Matemática , Criança , Humanos , Terminologia como AssuntoRESUMO
AIMS: To review some aspects of learning and its difficulties, learning understood as meaning a process that allows the nervous system to develop, and also as acquisition and consolidation, and as a synaptic and neocortical process. Likewise, we also intend to analyse the role played by the environment as well as the relations between learning and maturing, and between learning and plasticity. It is also our aim to define learning difficulties and to discuss how they can be classified. Finally, this study also seeks to consider diagnosis and the different possibilities it may offer. DEVELOPMENT: The main issue analysed here is the diagnosis of learning disorders, which is classified as being either positive (syndromatic, topographic, aetiological) or differential; the paper also describes the ways such diagnoses can be carried out and the role played by an interdisciplinary team is underlined. CONCLUSIONS: Attention is drawn to the importance of this subject owing to the large numbers of children who visit a specialist because of a possible learning disorder. At the same time we also highlight the fact that the members of the team that study these children will need to have a sound and comprehensive training because of the many pathologies that may be at play. Lastly, we discuss the need to conduct this research to resolve certain aspects that are not well understood.
Assuntos
Deficiências da Aprendizagem/diagnóstico , Aprendizagem , Criança , Humanos , Aprendizagem/fisiologiaRESUMO
AIMS: The objective of this study was to determine the relations that exist between attention and the executive functions, and between attention deficit hyperactivity disorder (ADHD) and dysexecutive syndrome, while at the same offering a definition of these terms. To achieve this, several aspects related to attention and the executive functions are reviewed, including the evolution of the concept, the different types and the anatomical location. DEVELOPMENT: The analysis investigates the possible relations between attention and the executive functions, and the modifications that have taken place in ADHD over time, which leads us to consider whether it is the children themselves and the factors that may have influenced these differences. The work then moves on to analyse the possible explanation behind the most frequent symptoms: attention deficit, hyperactivity and impulsiveness, and more especially whether they can be symptoms of executive dysfunction. The possibility of several clinical forms then arises. Finally, we accept the possible cause as being due to an alteration in neurotransmitters, especially dopamine and noradrenalin. A discussion is also included on whether the new interpretation, executive dysfunction, entails a different treatment and whether this offers some benefit for the child. CONCLUSIONS: Attention is related to the executive functions, but it is not one of them. ADHD has several clinical forms, one of which (although not the only one) may be dysexecutive syndrome. The clinical symptoms may be caused by a delay in the development of distinct neurotransmitter systems.