In a multinational study of children with acute liver failure, we found that incorporating diagnostic test recommendations into electronic medical record order sets accessed at time of admission reduced the percentage with an indeterminate diagnosis that may have reduced liver transplants without increasing mortality. Widespread use of this approach could significantly enhance care of acute liver failure in children.

A multivariate analysis was carried out in 492 patients with metastatic neck disease from squamous cell carcinoma to determine the influence of clinical and therapeutic factors on survival, local and regional control, and distant metastases. After radiation treatment with radical intent, recurrence at the primary site was the most frequent site of treatment failure (20% of cases), followed by distant metastases (14% of the cases), whereas isolated neck recurrences occurred in only 7% of the patients. The most significant factors influencing survival were primary tumor site, node fixation, N-stage, T-stage, and number of lymphatic chains. The most significant factors influencing local control were primary site, T-stage, and node fixation. Significant factors influencing regional control were radiation therapy volume, primary tumor site, node fixation, and node location (upper and lower neck). Significant factors influencing distant control were N-stage, number of nodes, and number of involved lymphatic chains. Cancer 1992; 69:1224-1234.In head and neck cancer the presence of clinically involved lymph nodes (Stages I11 and IV) seems to be a major determinant of patient outcome.'-3 Despite the advances of surgery and radiation therapy, tumor control and survival remain disappointing, and a multidisciplinary approach often has been a d~o c a t e d .~,~ Some studies have analyzed the patterns of failure in this group of patients, either considering a specific tumor site6-8 or head and neck tumors in These generally have shown that the recurrence at the primary site is the main cause of tumor failure. In addition, some major prognostic factors have been previously defined mainly based on information from the neck d i s~e c t i o n .~~'~~'~ The effect on prognosis is less clear for other clinical parameters, which might be useful in determining the likelihood of eradicating the cancer with locoregional treatment or might indicate the need for additional systemic therapy. This study attempts to identify, by means of a multivariate analysis, the clinical and treatment factors most significantly associated with survival, local and regional recurrences, and distant metastases in a large series of patients with squamous cell carcinoma of the head and neck (SCCHN) and clinically positive neck nodes.. Patients and Methods PatientsWe have retrospectively reviewed 492 patients with previously untreated SCCHN and clinically positive neck nodes at diagnosis who where treated with radical radiation therapy at the Clinica Puerta de Hierro, Madrid, Spain, between 1965 and. The Department of Radiation Oncology receives patients from the Surgery Department of this hospital and other hospitals in the country with ap indication of radiation therapy. Patients with histology other than squamous cell carcinoma with previous cancer, distant metastases at presentation, those who had primary surgical treatment other than a biopsy, and those who did not finish a radical course of radiation were excluded from the analysis.The median age was 53 ...

Coronavirus illness 2019 (COVID-19) is an airways infection caused by the new coronavirus (SARS-CoV-2) which has been quickly disseminated all over the world, affecting to the general population including women in pregnancy time. As being a recent infection, the evidence that supports the best practices for the management of the infection during pregnancy is limited, and most of the questions have not been completely solved yet. This publication offers general guidelines focused on decision-making people, managers, and health’s teams related to pregnant women attention and newborn babies during COVID-19 pandemic. Its purpose is to promote useful interventions to prevent new infections as well as prompt and adequate attention to avoid serious complications or deaths, trying to be adapted to the different contexts in which attention to expectant mothers is provided. Guidelines are set within a well-scientific evidence and available recommendations up to date.

IntroductionThere is no unanimous consensus on the clinical features to define breakthrough cancer pain (BTcP). The current project aimed to investigate the opinion of a panel of experts on cancer pain on how to define, diagnose, assess, treat and monitor BTcP.Materials and methodsA two-round Spanish multi-centre exploratory Delphi study was conducted with medical experts (n = 90) previously selected from Medical Oncology Services, Radiation Oncology, Palliative Care/Home Care Teams, and Pain Units. The study intended to seek experts’ consensus and to define a set of recommendations for the management of BTcP.ResultsIt was generally agreed that, definition of BTcP implies that baseline pain should be controlled (84 %), although not necessarily with opioids (only 30 %); there must be exacerbations (98.9 %); the duration of each episode should last <1 h (70 %); the intensity of pain ≥7 out of 10 (67.8 %); and the number of flares per day should not be less than four. All participants supported the use of the Davies algorithm for the diagnosis. The use of a ‘Patient Diary’ was highly recommended. The optimal treatment should have a rapid onset, a short-acting analgesic effect (1–2 h) and transmucosal nasal or oral administration. It was considered very important to develop protocols for the management of cancer pain.ConclusionsThe present Delphi study identified a set of recommendations to define, assess and monitor BTcP.

Chordomas are tumors with a bad prognosis, because of their location, local aggressiveness and high rate of local relapse. Despite of be benign tumors, they have certain capacity of metastasize and a clinical evolution that results interesting. When we analyzed our series with 35 chordomas studied and treated between 1975 and 2002, we found three patients that experienced a systemic dissemination.