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Jul;14 7 Ann Rheum Dis Oct;74 10 Epub May 19 Gago-Fuentes R. Osteoarthritis and Cartilage. Mayan M. Am J Pathol. Goldberg G. Ann Rheum Dis. Epub Nov PLoS One. Freire-Picos M. Cdc14 phosphatase promotes segregation of telomeres through repression of RNA polymerase II transcription. Nature Cell Biology, 13, Maria Mayan and Luis Aragon. Cell Cycle , ; November 1, Clemente-Blanco, A. Cdc14 inhibits transcription by RNA polymerase I during anaphase.

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Int J Dermatol. DOI: Genome-wide transcriptional analysis of T cell activation reveals differential gene expression associated with psoriasis. Long-term response to etanercept monotherapy in moderate to severe psoriasis. Assessment in daily practise by the maintenance of low values of pasi and bsa. J Dermatol Treat ; Spitzoid and non-spitzoid melanoma in children. A prognostic comparative study. J Eur Acad Dermatol Venereol ; Psoriasis and cardiovascular risk.

Assessment by different cardiovascular risk scores. J Eur Acad Dermatol Venereol ; Risk variants for psoriasis vulgaris in a large case-control collection and association with clinical subphenotypes. Psoriasis in patients older than 65 years.

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A comparative study with younger adult psoriatic patients. Long-term efficacy of infliximab in hidradenitis suppurativa. Congenital Langerhans cell histiocytosis involving only one of non-identical twins.

Eur J Dermatol ; Melanoma in children. Implications and usefulness: How important are these findings to policy and practice? These two models, both published in and applying to hospital settings, achieved a high quality score Hawker et al. Both were observational studies, the first of which addressed non-cancer patients suffering from advanced chronic disease, identified and evaluated through an exhaustive multidimensional study and interdisciplinary teamwork in a long stay hospital delivering end-of-life care [ 11 ].

Four clinical guidelines for cancer and non-cancer were identified. This guideline is in line with the other three identified in that they all included recommendations about PC interventions to reduce suffering [ 14 — 16 ]. Three pathways in cancer and non-cancer were found. One pathway referred to out-of-hospital emergencies [ 17 ], another related to home settings [ 18 ], and finally, one applied to both [ 19 ]. One clinical guideline [ 22 ] and two pathways one relating to Chronic Obstructive Pulmonary Disease COPD and the other, general chronic advanced illness were identified [ 23 , 24 ].

They were published between — and apply to all settings. All exceeded the initial filter of achieving at least two out of the 11 criteria. With regard to the recommendations appearing, there exist large variations. These recommendations were found in three quarters of the selected documents. Conversely, the least cited recommendations are those related to the timing of assessments and to continuous goal adjustment as illness progresses. Additional file 1 : Table S1. Amongst these, there are papers describing diverse programmes with fruitful collaborations between PC teams and oncology departments in a narrative review of patients suffering from advanced chronic respiratory disease [ 25 ]; descriptions of an integrated PC process [ 21 , 26 ] and a description of how care provision for terminal cancer patients was organised in Andalucia in the year [ 27 ].

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These strategic documents are particularly important in Spain due to the nature of the Spanish National Health System, as it is a decentralised governmental system where healthcare regions have considerable control on the delivery of health care. Analytical studies mainly focused on integration of PC into primary care, resource utilisation, focusing on cancer, dementia, and other non-cancer conditions. In contrast to the models noted above , these scored moderately against the Hawker et al. The observational studies include descriptive and retrospective designs describing and analysing clinical records, whereas the experimental studies involved pro-actively engaging with patients and PC professionals as study participants.

These adopted diverse study designs including: retrospective, population-based, descriptive, structured and semi-structured interviews, quasi-experimental prospective and prospective cohort studies. The settings to which these studies apply varied from PC units in long term and general hospitals, home care situations and wider health regions.

All these studies conclude that IPC have positive impacts on the quality of life of patients and their families, improves patient perception of their own health condition, and reduces inpatient deaths and hospitalizations in the last months of life. A total of 49 documents including models, clinical guidelines and pathways, and other strategic, descriptive and analytical documents have been identified. Strategic, analytical and descriptive studies evaluated with Hawker et al.

In contrast, the number identified for chronic advanced diseases suggest that Spain is at an early stage if we take chronic obstructive pulmonary disease or chronic heart failure CHF as exemplars. Only a few of these could be considered robust in terms of developmental methods and level of evidence, as they are supported mainly on consensus processes, and further evaluation should be applied to evaluate quality. These —jointly with the previously indicated guideline-, place an emphasis in organisational and clinical aspects bearing in mind the importance of coordination, dialogue and constant relationship between units and assistance levels.

All aiming to guarantee continuity of care between all agents involved in the PC process. Overall, this review demonstrates some progress in IPC by Spanish health providers and policy makers and suggests general agreement on the need for the integration of palliative care in service provision. This is supported by the existence of strategic documents and it seems that planning for IPC is a major concern for the Spanish Public Health System and its different regional services. That said, implementation plans should be developed beyond the theory [ 42 , 43 ].


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On this basis, the challenge of integrating multidisciplinary PC teams, attention to continuity of care, and coordination between different levels is already being addressed [ 3 ]. Other studies are proceeding similarly, for example by reviewing the current situation of IPC in the region of Catalonia and moreover, identifying possible areas of improvement [ 40 , 45 ]. The focus of this paper is Spain, as a whole, and suggests the need for further research on the topic, in order to improve the quality of life and palliative care provision for patients and their families.

International studies have recently investigated IPC at an European level, seeking and analysing guidelines and pathways for adult cancer patients [ 46 ], for COPD or CHF patients [ 47 ], and another non-published paper seeking empirically-tested models both in cancer and chronic diseases [ 48 ]. Lately, a full and varied body of research has been published including several reviews on IPC from diverse perspectives. Amongst them, there is a review of evidence reporting the positive impact of engaging communities in end-of-life care [ 49 ].

Secondly, an integrative review addresses paediatric PC and psychosocial support in oncology settings, revealing a set of issues to develop comprehensive psychosocial PC standards [ 50 ]. Finally, a narrative synthesis reviewing themes that facilitate and hinder collaboration between hospital-based generalist PC professionals and in-patient specialist PC professionals, finds out five themes essential to either enhancing or worsening effective collaboration: model of care, professional onus, expertise and trust, skill building and specialist PC operations [ 52 ].

Readers should be aware that the number of sources used in this review is limited PUBMED, Cochrane Library, Cinahl, Google, Medicina Paliativa although we have considered the most appropriate available for our context. It must be also acknowledged that the Google hits considered stopped when reaching hits as Google itself orders and allocates in first positions most relevant documents, which does not mean that other results could have been considered.

The concept of IPC itself remains a developing concept with all its implications in terms of robust, published research. This is a first work in this area relating to Spanish-speaking countries. We suggest that others could benefit from this and may seek to replicate our methods to investigate the situation of IPC in their own countries literature. A beneficial approach for the future might be to test whether models, plans, guidelines and pathways, as outlined above, have been used with positive effect and demonstrable service improvements for patients and families in receipt of palliative care.

These aspects could allow to compare and implement a kind of benchmarking which could be useful for policy makers and managers among others. The existence of scarce implemented IPC models, the number and quality of clinical guidelines and pathways, and the large amount of other relevant documents addressing IPC seem to demonstrate that IPC is at an incipient development stage in Spain.

Documents from a strategic, descriptive and analytical perspective, overall point out the achievements in terms of policy makers and health providers agreements and contextualise a potential environment. From our review, it can be said that first steps towards IPC in Spain have been made, but the literature lacks sufficient evidence about implementation and therefore highlights that much work remains to be done. This systematic review is an adaptation of an ongoing European project InSup-C: www. The Spanish team has followed the same aim and adapted the method, and continues other studies on the topic already investigating if PC is integrated or not into the Spanish National Health System, at different assistance levels, and into non-cancer conditions.

InSup-C aims to identify the prerequisites for best practice in integrated palliative care with the overall objective of improving service delivery and service user outcomes. We would like to specially thank Nancy Preston, Sean Hughes and Sheila Payne for their collaboration in the language editing of the article, and the whole InSup-C project for their constant assistance and revision.

Competing interests. All authors read and approved the final manuscript. JMC, graduate in Political Sciences and Sociology, and doctor in Public Health, experienced researcher in epidemiology population and clinic and in public health fields, using both quantitative, qualitative and consensus methodologies. KVB, oncologist at the Dept. NS, psychologist who is receiving doctoral training in Biomedical Sciences Leuven, Belgium and researcher involved in the InSup-C European project on integrated palliative care.

AC, Medical Director at the Pecs-Baranya Hospice Foundation, provides patient care and palliative care consults for primary care physicians. She is an Associate Professor at the Institute of Family Medicine, University of Pecs Medical School, Hungary teaching medical, nursing and pharmacy students, residents and continuing medical education courses. JM, radiation Oncologist and coordinator palliative care for the palliative support team and the palliative care unit of 12 beds in the University Hospital, Leuven.

National Center for Biotechnology Information , U. BMC Palliat Care. Published online May Author information Article notes Copyright and License information Disclaimer. Eduardo Garralda, Phone: , Email: se. Corresponding author. Received Jan 19; Accepted May 4. This article has been cited by other articles in PMC. Abstract Background Integrated palliative care IPC involves bringing together administrative, organisational, clinical and service aspects in order to achieve continuity of care between all actors involved in the care network of patients receiving palliative care PC services.

Results Out of a total of 2, titles screened, 49 were included. Conclusions The results show that explications of IPC in the Spanish literature exist, but that there is insufficient evidence of its impact in clinical practice. Electronic supplementary material The online version of this article doi Background The European Union is experiencing an acute ageing of the population in recent decades with growing numbers of patients suffering from cancer and non-cancer disease [ 1 ].

Open in a separate window. Search criteria The search period dated from January based on the publication year of the Calman-Hine report [ 6 ] which constitutes the first national cancer plan in Europe to December Data selection We concentrated on evidence addressing models, guidelines and pathways in IPC in cancer and chronic advanced disease. Content assessment Specific information relating to pathways and guidelines such as description of the document, inflection point prognosis , and the presence of a separate reference to another guideline or pathway, were included in the database.

Quality assessment A quality assessment process agreed by the project research team was made to determine the quality of the guidelines and pathways according to the manner in which they were developed: systematic review, consensus methods, evidence based and quality assessment; systematic review and consensus methods; systematic review only; consensus methods only; unclear methods; and other options. Ethical approval Ethical approval was not required as all the information is already published and human beings were not involved.

Flow diagram of the systematic review modified from Moher et al. Improvement in continuity of care, coordination amongst assistant bodies, increase in mean stay at the PCU a , increase in number of home deaths, etc. PC home care improves continuity in care of patients.

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Navarro et al. General data, terminal criteria, diagnostic and prognostic information, development of advance directives, limiting levels of effort care, times from admission, risk of complicated bereavement. Un estudio cualitativo desde la perspectiva de profesionales, pacientes y personas cuidadoras Needs in PC of the non oncologic diseases. Proyecto Oncoguias Palliative Care for the oncologic patient. Documents for integrated management of assitential processes related to Cancer. Proceso asistencial integrado Araba Palliative Care. Training guideline for resident of radiotherapic oncology Concrete situations Radiotherapic oncology Not applicable None Not applicable Castellanos et al.

None 19 Ko W et al. Observational Cancer Retrospective study None 28 Alonso et al. Descriptive and retrospective study Urban basic health area of Terrasa Barcelona 21 Riera et al. A new palliative care consultation team at the oncology department of a university hospital: an assessment of initial efficiency and effectiveness Experimental Cancer and non-cancer Retrospective study University of Navarre Clinic, Oncology department.

Pamplona, Spain 22 Alonso-Babarro et al. The association between in-patient death, utilization of hospital resources and availability of palliative homecare for cancer patients Experimental Cancer Population-based study Alcobendas-San-Sebastian de Los Reyes and Alcala de Henares districts 31 Vega et al. Multidisciplinary cancer care in Spain, or when the function creates the organ: qualitative interview study Experimental Cancer Qualitative interview study with semi-structured, one-to-one interviews Most populated regions of Spain, namely, Andalusia, Catalonia, Madrid, Galicia and Valencia 19 Colchero et al.

And finally both interventions were compared Unit of Oncology in the University of Salamanca Guidelines and pathways Guidelines and pathways on both malignant and non-malignant diseases Four clinical guidelines for cancer and non-cancer were identified. Guidelines and pathways on non-cancer One clinical guideline [ 22 ] and two pathways one relating to Chronic Obstructive Pulmonary Disease COPD and the other, general chronic advanced illness were identified [ 23 , 24 ].

Descriptive documents Amongst these, there are papers describing diverse programmes with fruitful collaborations between PC teams and oncology departments in a narrative review of patients suffering from advanced chronic respiratory disease [ 25 ]; descriptions of an integrated PC process [ 21 , 26 ] and a description of how care provision for terminal cancer patients was organised in Andalucia in the year [ 27 ].

Discussion A total of 49 documents including models, clinical guidelines and pathways, and other strategic, descriptive and analytical documents have been identified. Conclusions The existence of scarce implemented IPC models, the number and quality of clinical guidelines and pathways, and the large amount of other relevant documents addressing IPC seem to demonstrate that IPC is at an incipient development stage in Spain. Ethics approval and consent to participate There are no human participants involved. Availability of data and materials Not applicable.

Acknowledgements This systematic review is an adaptation of an ongoing European project InSup-C: www. Footnotes Competing interests The authors declare that they have no competing interest. JH, assistant Professor in Radboud University Medical Centre Nijmegen, researcher and project leader and coordinator of the InSup-C EU- on integrated Palliative Care as an European FP7 funded project JMC, graduate in Political Sciences and Sociology, and doctor in Public Health, experienced researcher in epidemiology population and clinic and in public health fields, using both quantitative, qualitative and consensus methodologies.

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Practice gudelines. Updated European pathway association. Appraising the evidence: Reviewing disparate data systematically. Qual Health Res. Integrating palliative care into disease management guidelines. J Palliat Med. Med Pal. Influencia del plan integral de cuidados paliativos de la comunidad de madrid en la actividad de una unidad de cuidados paliativos hospitalaria. Comunidad de Madrid, Madrid, Manual para el manejo del paciente en cuidados paliativos en urgencias extrahospitalarias.

Barcelona: Arrow conept SL; Proceso asistencial integrado de cuidados paliativos, 2e. Cuidados paliativos. Proceso asistencial integrado araba. Servicio Central de Publicaciones del Gobierno Vasco, Arnedillo A. Barcelona: Generalitat de Catalunya, Departament de Salut; Modelos de cuidados paliativos en pacientes con cancer. Pascual N. Granada: Universidad de Granada; Plan andaluz de cuidados paliativos. Estrategia de cuidados paliativos para asturias.