https://hdl.handle.net/2072/452966 2026-03-28T03:10:33Z 2026-03-28T03:10:33Z Jiménez Carrascal, Ivan https://hdl.handle.net/10256/28586 2026-03-28T00:23:43Z 2025-10-01T00:00:00Z

Postoperative pain in patients with opioid tolerance: the importance of therapeutic individualisation Jiménez Carrascal, Ivan Background: patients with chronic cancer pain are often treated with opioids for pain relief. However, their exposure leads to tolerance and alterations in the nociceptive signal, requiring increased doses to achieve the same pain control. This is one of the reasons why this group is considered difficult to manage in anaesthesiology. In addition, the lack of specific studies and protocols for this population results in poorer analgesic management and an increase in postoperative complications compared with opioid-naïve patients. Objective: the main objective is to compare the effect of individualizing the intravenous morphine rescue dose in PCA (Patient-Controlled Analgesia) devices based on preoperative opioid dose on the proportion of patients achieving acceptable pain control (Numerical Rating Scale ≤3 at rest, 24 h postoperatively) compared with a standard PCA morphine dose, in opioid-tolerant patients undergoing laparoscopic abdominal oncologic surgery. Study design and participants: this trial is a randomised, double-blind, multicentre, prospective, controlled trial that will study 336 patients (≥18 years) exposed to ≥60 mg oral morphine equivalent for ≥7 days, scheduled for laparoscopic oncologic abdominal surgery at Hospital Universitari Doctor Josep Trueta or Bellvitge University Hospital over one year. Methods: participating patients who have provided informed consent will be randomised 1:1 into two groups: standard PCA morphine rescue dose according to the institutional protocol or individualised PCA morphine dose adjusted to the patient's preoperative oral morphine equivalent (OME). During the postoperative stay in the Post-Anaesthesia Care Unit (PACU), patients will be controlled during the first 24 hours, where they will receive multimodal analgesia according to the protocol. At 24 hours, the proportion of patients with acceptable pain at rest (NRS ≤3) will be measured; 3

2025-10-01T00:00:00Z Tarradas Juncà, Rafel https://hdl.handle.net/10256/28585 2026-03-28T00:23:42Z 2025-10-01T00:00:00Z

Improving post-discharge care in infective endocarditis patients not undergoing otherwise indicated cardiac surgery: protocol for a multicenter randomized clinical trial to evaluate mortality and sex- and age-related differences Tarradas Juncà, Rafel BACKGROUND: Infective endocarditis is associated with high morbidity and mortality, especially among patients with a surgical indication who do not undergo cardiac surgery (SINUS-IE). After hospital discharge, these patients remain at high risk of complications, yet standardized follow-up protocols are lacking. OBJECTIVES: The primary objective is to compare 12-month mortality between patients with SINUS-IE enrolled in a specific multidisciplinary follow-up program after hospital discharge and those receiving usual care. Secondary objectives include assessing whether the effect of the program on mortality differs according to sex or age. STUDY DESIGN: This is a prospective, multicentric, randomized, open-label, controlled clinical trial conducted in four Spanish tertiary referral centers. PARTICIPANTS: Recruitment is expected to last 12 months, with each patient followed for one year. A total of 78 participants who meet the inclusion and exclusion criteria will be enrolled and randomized in two groups across four tertiary referral centers in Catalonia; 3

2025-10-01T00:00:00Z Estanyol Costa, Marina https://hdl.handle.net/10256/28579 2026-03-27T00:12:47Z 2026-01-01T00:00:00Z

Can carotid artery stenting achieve comparable outcomes to endarterectomy in symptomatic extracranial carotid stenosis?: towards an individualized revascularization strategy: a multicenter randomized clinical trial Estanyol Costa, Marina Background: Carotid revascularization is a key component in the secondary prevention of stroke in patients with symptomatic extracranial carotid stenosis. Carotid endarterectomy (CEA) has traditionally been considered the gold-standard treatment, based on evidence from randomized controlled clinical trials demonstrating a lower periprocedural neurological risk compared to Carotid artery stenting (CAS). However, advances in stent technology, cerebral protection devices (EPDs), operator experience, and peri-procedural management may have substantially improved the safety profi le of CAS, warranting a re-evaluation of its role in contemporary clinical practice. Objective : The aim of this study is to assess whether CAS is non-inferior to CEA in terms of early safety outcomes, specifi cally the risk of stroke or death within 30 days after the procedure, in patients with symptomatic extracranial carotid stenosis. Methods : This is a multicenter, randomized, controlled, non inferiority clinical trial conducted across eight hospitals in Spain. Patients admitted with ischemic stroke or transient ischemic attack (TIA) including amaurosis fugax attributable to a symptomatic extracranial carotid stenosis greater than 50% will be randomly assigned to undergo either CEA or CAS. All procedures will be performed by experienced multidisciplinary teams using contemporary techniques and standardized cerebral protection strategies. The primary endpoint is the composite outcome of stroke or death within 30 days following carotid revascularization. Expected impact : By generating high-quality evidence using modern revascularization techniques, this study aims to support a more balanced evidence-based selection of carotid revascularization strategies. Demonstrating non-inferiority of CAS compared with CEA could promote a safer, more equitable, and broader application of both techniques in patients with symptomatic extracranial carotid stenosis, optimizing individualized patient care; 3

2026-01-01T00:00:00Z Martínez Álvarez, Carla https://hdl.handle.net/10256/28576 2026-03-27T00:12:46Z 2025-06-03T00:00:00Z

El comerç local dins la xarxa de suport comunitari a Vidreres: detecció i acompanyament de persones grans en situació o risc de soledat Martínez Álvarez, Carla Aquest article aborda la soledat no desitjada en la vellesa en entorns semiurbans, orientat en el municipi de Vidreres. L’objectiu principal de l’estudi és analitzar la viabilitat d’una xarxa de suport comunitari per a persones grans en situació o risc de soledat, amb els comerços locals com agents de detecció i suport. Mitjançant una aproximació teòrica i una recerca qualitativa amb entrevistes semiestructurades a diversos agents del territori, s’identifiquen les barreres com la dispersió territorial i la cultura de l’autosuficiència i els facilitadors. Entre aquests últims, destaquen les relacions de confiança entre comerciants i clients, la predisposició col·laborativa del teixit comercial i institucional, i el reconeixement del comerç de proximitat. Els resultats evidencien que el comerç local pot esdevenir un recurs comunitari rellevant si s’adapten les estratègies pertinents a les característiques del territori, amb suport institucional, protocols clars i formació. A més, es proposen criteris per seleccionar i capacitar els agents implicats, destacant l’empatia, l’arrelament i la coordinació. Es conclou que una xarxa informal, propera i adaptada pot ser una resposta viable per combatre la soledat no desitjada de les persones grans a Vidreres i altres municipis amb característiques similars; This article addresses unwanted loneliness among the elderly in semi-urban contexts, focused on the municipality of Vidreres. The main objective is to analyse the viability of a community support network for older adults who are experiencing or at risk of loneliness, with local businesses acting as key agents of detection and support. Through a theoretical overview and qualitative research using semi-structured interviews with various local agents, the study identifies barriers such as territorial dispersion and culture of self-sufficiency as well as facilitators. Key facilitators include trustful relationships between shopkeepers and customers, the collaborative willingness of commercial and institutional networks and the recognition of local businesses. The results suggest that local commerce can become a significant community resource if appropriate strategies are adapted to the territory’s characteristics and supported by institutions, clear protocols, and training. Additionally, criteria for selecting and training involved agents are proposed empathy, rootedness, and coordination. It is concluded that an informal, close and adapted network may offer a viable response to unwanted loneliness among older adults in Vidreres and other municipalities with similar characteristics; 3; 11

2025-06-03T00:00:00Z