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Díez, Enrique Grande, Teresa Alonso, Pedro Iglesias" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Juan J." "apellidos" => "Díez" ] 1 => array:2 [ "nombre" => "Enrique" "apellidos" => "Grande" ] 2 => array:2 [ "nombre" => "Teresa" "apellidos" => "Alonso" ] 3 => array:2 [ "nombre" => "Pedro" "apellidos" => "Iglesias" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020615003460" "doi" => "10.1016/j.medcle.2015.12.041" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020615003460?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775315000263?idApp=UINPBA00004N" "url" => "/00257753/0000014500000001/v1_201506170215/S0025775315000263/v1_201506170215/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2387020615003575" "issn" => "23870206" "doi" => "10.1016/j.medcle.2015.12.047" "estado" => "S300" "fechaPublicacion" => "2015-07-06" "aid" => "3092" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2015;145:42-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 38 "formatos" => array:2 [ "HTML" => 33 "PDF" => 5 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Usefulness of a diagnostic algorithm hyperferritinemia: A case report of a Spanish family with hereditary hemochromatosis and mutation in SLC40A1 gene" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "42" "paginaFinal" => "43" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad de un algoritmo diagnóstico en la hiperferritinemia: presentación de una familia española con hemocromatosis hereditaria y mutación en el gen <span class="elsevierStyleItalic">SLC40A1</span>" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan Antonio Vargas, Alejandro Muñoz, Begoña Samper, Belén Bornstein" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Juan Antonio" "apellidos" => "Vargas" ] 1 => array:2 [ "nombre" => "Alejandro" "apellidos" => "Muñoz" ] 2 => array:2 [ "nombre" => "Begoña" "apellidos" => "Samper" ] 3 => array:2 [ "nombre" => "Belén" "apellidos" => "Bornstein" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775314006289" "doi" => "10.1016/j.medcli.2014.09.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775314006289?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020615003575?idApp=UINPBA00004N" "url" => "/23870206/0000014500000001/v1_201602160042/S2387020615003575/v1_201602160042/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2387020615003587" "issn" => "23870206" "doi" => "10.1016/j.medcle.2015.12.048" "estado" => "S300" "fechaPublicacion" => "2015-07-06" "aid" => "3074" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "cita" => "Med Clin. 2015;145:31-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 42 "formatos" => array:2 [ "HTML" => 28 "PDF" => 14 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "Diabetes and periodontitis: A bidirectional relationship" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "31" "paginaFinal" => "35" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Diabetes y periodontitis: una relación bidireccional" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1285 "Ancho" => 2170 "Tamanyo" => 167971 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Biological plausibility of the relationship between diabetes and periodontitis. AGE, advanced glycation end-products; MMP, matrix metalloproteinases; PMN, polymorphonuclear lymphocytes; RAGE, receptor for advanced glycation end-products.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Antonio Bascones-Martínez, Marta Muñoz-Corcuera, Jaime Bascones-Ilundain" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Antonio" "apellidos" => "Bascones-Martínez" ] 1 => array:2 [ "nombre" => "Marta" "apellidos" => "Muñoz-Corcuera" ] 2 => array:2 [ "nombre" => "Jaime" "apellidos" => "Bascones-Ilundain" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775314005715" "doi" => "10.1016/j.medcli.2014.07.019" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775314005715?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020615003587?idApp=UINPBA00004N" "url" => "/23870206/0000014500000001/v1_201602160042/S2387020615003587/v1_201602160042/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Special article</span>" "titulo" => "Multidisciplinary approach in the diagnosis and therapy of patients with endocrine tumors" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "36" "paginaFinal" => "41" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Juan J. Díez, Enrique Grande, Teresa Alonso, Pedro Iglesias" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Juan J." "apellidos" => "Díez" "email" => array:1 [ 0 => "juanjose.diez@salud.madrid.org" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Enrique" "apellidos" => "Grande" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "Teresa" "apellidos" => "Alonso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Pedro" "apellidos" => "Iglesias" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Endocrinología, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Medicina, Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Abordaje multidisciplinar en el diagnóstico y tratamiento de pacientes con tumores endocrinos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2696 "Ancho" => 3249 "Tamanyo" => 546439 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Location of the main endocrine tumors.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The prognosis and survival of patients with tumors of the endocrine system have improved following new insights into risk factors and the molecular mechanisms involved in the genesis and progression of these tumors, and improvements in diagnostic procedures leading to early detection and therapeutic advances. In this study, we review the most important aspects of multidisciplinary care in the field of endocrine tumors (ETs), and present the experience of the Endocrine Tumor Board (ETB) of the Hospital Universitario Ramón y Cajal, the first of its kind in Spain.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Description and epidemiology of endocrine tumors</span><p id="par0010" class="elsevierStylePara elsevierViewall">ETs are a heterogeneous group of benign and malignant neoplasms deriving from the oncogenic transformation of endocrine gland, diffuse endocrine system, and neural crest-derived neuroendocrine cells (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The annual incidence of ETs<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">1–14</span></a> is not very high compared to other tumors (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), but has increased in recent years.<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">15</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Parathyroid gland tumors, most of which are benign, are the most common ETs.<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">1–3</span></a> Those deriving from the adrenal glands have been found to have a frequency of 2.5% in autopsy series<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">16</span></a> and 4%–10% in imaging studies,<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">17</span></a> although adrenal cancer is rare.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">5</span></a> The annual incidence of thyroid cancers in Spain from 1978 to 1985 was 1.56 per 100,000 in women and 0.33 per 100,000 in men. From 1994 to 2001, the incidence was 8.32 and 2.65 per 100,000, respectively, a 5.3- and 8-fold increase in women and men, respectively.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">4</span></a> Until very recently, pituitary adenomas were considered rare. However, 2 recent studies have shown prevalences of 77.6 per 100,000 in the United Kingdom<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">6</span></a> and 94 per 100,000 in Belgium,<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">7</span></a> with a prevalence of 14.4% and 22.5% in autopsy and imaging studies, respectively.<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">18</span></a> The incidence of neuroendocrine tumors (NETs) has also increased significantly. According to data from the US SEER registry, 1 patient per 100,000 was diagnosed with NET in 1973, and this number increased to 5.25 per 100,000 in 2004.<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">11</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Complexity of endocrine tumors</span><p id="par0020" class="elsevierStylePara elsevierViewall">ET diagnosis and complications associated with these tumors require clinical expertise and high-complexity diagnostic testing. There are more than 20 different techniques in imaging tests alone,<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">19</span></a> as well as a broad array of laboratory, nuclear medicine and pathology tests (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Histological classification of ETs is complex. A good example of this can be seen in the changes made to NET classifications in recent years. The World Health Organisation classification, last updated in 2010,<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">20</span></a> divides neuroendocrine neoplasms according to their histological differentiation grade, while the European Neuroendocrine Tumor Society classifies them according to mitotic count and Ki-67 proliferation index. The prognostic power of both systems has been shown to be similar.<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">21</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Therapeutic procedures, such as the recent introduction of endoscopic techniques in neurosurgery, have become significantly more complicated in recent years.<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">22</span></a> Surgical techniques for treating NETs have improved and can now be adapted to each patient, based on the type and location of the tumor.<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">23</span></a> Radiotherapy uses stereotactic techniques that are not available in every hospital.<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">24</span></a> Radioembolisation, chemoembolisation and radiofrequency ablation techniques must be performed by different specialists.<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">25</span></a> Radiolabelled peptide therapies for the treatment of NETs always require multidisciplinary evaluation.<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">26</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Therapeutic algorithms for the most common tumors have changed greatly.<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">27,28</span></a> Pharmacological treatments in advanced tumors have evolved dramatically in recent years. Various lines of treatment using new multi-target agents have been introduced in advanced thyroid cancer cases.<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">29,30</span></a> In the case of NETs, treatments with somatostatin analogues,<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">31</span></a> mTOR inhibitors<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">32</span></a> and tyrosine kinase inhibitors<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">33</span></a> have been shown to increase survival. Pharmacological treatment of pituitary tumors has also improved in recent years with the development of new somatostatin analogues<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">34</span></a> and anti-cancer drugs.<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">35</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Multidisciplinary healthcare models</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Limitation of traditional models</span><p id="par0040" class="elsevierStylePara elsevierViewall">Traditional healthcare models have their limitations and do little to facilitate patient access to various different healthcare services. Patients with complex tumors are assessed by different specialists, who are sometimes based in different locations and have different working hours, and undergo multiple, sometimes uncoordinated, diagnostic procedures. This leads to more or less prolonged delays in diagnosis and treatment, depending on the tumor. While the delay in the diagnosis and treatment of colon cancer is 18–44 days<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">36</span></a> and 98 days for lung cancer,<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">37</span></a> in the case of NETs it is 5–7 years,<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">38</span></a> and from 1 to 9.6 years in the case of the different tumors included in multiple endocrine neoplasia type 1.<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">39</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Multidisciplinary care concept</span><p id="par0045" class="elsevierStylePara elsevierViewall">Multidisciplinary care refers to the coordinated provision of patient-centred healthcare by a team of specialists in different fields based on a treatment plan that includes recommendations agreed upon by all involved.<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">40</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The multidisciplinary team caring for patients with ETs must therefore be formed of various clinical, laboratory and imaging specialists skilled in the diagnosis, treatment, monitoring and prevention of ETs, who can work together to achieve the therapeutic goals (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Advantages</span><p id="par0055" class="elsevierStylePara elsevierViewall">The implementation of any type of multidisciplinary approach is clearly advantageous for the patient, the clinics and the health system (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>). First of all, it improves <span class="elsevierStyleItalic">use of diagnostic procedures</span> by promoting the rational use of previously agreed diagnostic tests and avoiding duplication or unnecessary examinations.<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">41</span></a> In a recent study, Pawlik et al.<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">42</span></a> showed that <span class="elsevierStyleItalic">staging</span> improves when patients are treated by multidisciplinary teams. Several studies have clearly shown that teamwork also <span class="elsevierStyleItalic">reduces clinical variability and facilitates enrolment in clinical trials</span>.<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">42,43</span></a></p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Gabel et al.<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">44</span></a> compared a group of 162 breast cancer patients treated with traditional procedures to a group of 177 patients treated by a multidisciplinary team, and showed a <span class="elsevierStyleItalic">significant reduction in the time from diagnosis to start of treatment.</span> One study showed that the involvement of a multidisciplinary board <span class="elsevierStyleItalic">improved the choice of treatment</span> in 48 of 203 patients (23.6%).<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">42</span></a> A retrospective analysis by Wiesner et al.<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">45</span></a> showed that the creation of a multidisciplinary team improved <span class="elsevierStyleItalic">treatment outcomes</span> in pituitary adenomas.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Multidisciplinary care improves <span class="elsevierStyleItalic">patient satisfaction</span>, as it involves fewer visits and more consistent information, better patient safety<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">40</span></a> and improved quality of life.<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">46</span></a><span class="elsevierStyleItalic">Professional satisfaction</span> also improves, as teamwork gives insight into multiple aspects of the patient and reduces medical and legal risks.<a class="elsevierStyleCrossRefs" href="#bib0450"><span class="elsevierStyleSup">40,41,44</span></a> In addition, <span class="elsevierStyleItalic">institutional and management satisfaction</span> also improves, as this type of healthcare attracts patients to hospitals.<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">47</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The available evidence indicates that patients treated at hospitals with wide experience and multidisciplinary teams have <span class="elsevierStyleItalic">higher survival rates</span> than those treated at general hospitals,<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">48</span></a> so much so that the consensus statement on quality cancer care issued by American and European oncology associations (ASCO-ESMO) states that optimal cancer treatment should be provided by teams of medical experts from different specialties.<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">49</span></a><a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> shows the opportunities and challenges faced by multidisciplinary ET care teams.</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Structure and roles</span><p id="par0075" class="elsevierStylePara elsevierViewall">Metz et al.<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">50</span></a> suggest that the multidisciplinary team should be formed by a coordinator, a core team and a full or extended team. The coordinator takes final responsibility for the patient and is generally the same for each patient. Their role changes according to the stage of the disease. The structure of the core team depends on the stage of the disease and the treatments used. Various hospital specialists are involved in the extended team, as well as primary care physicians and nurses, depending on patient needs.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The ETB consists of a team of ET specialists who meet periodically to discuss clinical cases and take joint decisions. It is formed by a coordinator and a group of permanent specialists. The structure is open, and the team can invite non-permanent specialists to discuss specific cases. The number of permanent members and their specialty will depend on the specific characteristics of each hospital and its level of expertise and specialisation in various tumor types. Each board member takes diagnostic and therapeutic decisions related to their specialty and also undertakes specific administrative duties in respect of the board.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Hospital Ramón y Cajal Endocrine Tumor Board</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Definition and objectives</span><p id="par0085" class="elsevierStylePara elsevierViewall">Clinical Committees are management advisory bodies in which hospital staff can contribute to ongoing quality improvement. One of their main objectives is to resolve problems that may arise in the institution using an interdisciplinary approach. Their working groups are in charge of drawing up clinical performance criteria in accordance with evidence-based medicine. The Hospital Universitario Ramón y Cajal ETB, created in 2011, is one such interdisciplinary working group. It is formed of specialists interested in the prevention, diagnosis, treatment and rehabilitation of patients with any type of ETs. The board is part of the hierarchical structure of the Hospital Tumor Board.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The constitutional objective of the board is to develop the ET specialty area within the hospital. The specific objectives set out when it was created, which are still valid, are summarised in <a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>.</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Structure and operation</span><p id="par0095" class="elsevierStylePara elsevierViewall">The board is formed of representatives from various specialties involved in the clinical treatment of patients. Although other specialists can take part, the permanent specialties represented are (the number of members is shown in brackets): endocrinology (2), medical oncology (2), surgery (2), nuclear medicine (2), anatomical pathology (2), neurosurgery (1), oncological radiotherapy (2), otorhinolaryngology (2), clinical biochemistry (1) and radiodiagnostics (2). From a functional and administrative perspective, the board is run by a manager-coordinator and a secretary, who work together to provide cohesion and liaise with management and other departments. The board meets monthly on fixed dates that are set at the start of each year. If an urgent or extraordinary meeting is required, the secretary is in charge of convening the members by email, informing them of the date and place of the meeting.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Responsibilities</span><p id="par0100" class="elsevierStylePara elsevierViewall">The following are the obligations and duties of specialist members of the ETB: (1) ensuring that the activity of their group conforms to the constitutional aims of the board; (2) attending and actively participating in ordinary and extraordinary board meetings; (3) encouraging training or teaching activities in their respective fields; (4) encouraging research activity; and (5) justifying the operation and activities of the board to hospital management. The coordinator is also responsible for: (1) ensuring board members are aware of the latest developments in their field, communicating these developments and encouraging members to conduct research in their field; (2) periodically informing hospital management of any teaching or research activity originating within the board; (3) preparing an annual report on activities carried out by the board to be presented to hospital management and included in its annual report; and (4) supervising the organisation of all training and teaching activities organised by the board.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Activities</span><p id="par0105" class="elsevierStylePara elsevierViewall">Over the last 4 years, the Hospital Ramón y Cajal ETB has set an example to be followed both in the hospital and in other healthcare centres. From a care perspective, in the 4 years since its creation, 27 official ETB meetings have been held in which a total of 119 cases have been discussed from a multidisciplinary perspective. Sixteen clinical protocols for the treatment and multidisciplinary monitoring of different ETs have been developed and published on the hospital's website.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Since the ETB was created, 8 phase-2 and -3 clinical trials on NETs and 3 phase-3 clinical trials on thyroid tumors have been started at the hospital. These include 3 independent clinical research studies sponsored by researchers from the ETB. This increase in research activity has directly improved the quality of care we have been able to offer to our patients. In terms of the board's focus on teaching, trainee specialists regularly attend board meetings, and 2 biennial officially accredited continuous professional development courses, one on thyroid cancer and the other on NETs, have been organised.</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Options for improvement</span><p id="par0115" class="elsevierStylePara elsevierViewall">Collaborative care encourages the coordinated and consensual development of research projects, patient registries and tumor banks. Being formed by a group of specialists, the ETB is well poised to expand its network to include primary care medicine. Most patients are seen for the first time by physicians at this level, and primary care is the basis for good health management. The creation of an ETB also provides a reference hub that can connect and coordinate with other hospitals, thus establishing better networks and facilitating the development of registers or research studies.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Patients with ETs can be complex cases, requiring a comprehensive approach involving not only a physician, but also nursing staff who can meet patient needs, provide education in self-care, and explain the side effects of the different treatments and how they should be managed. Social workers are at times essential to ensure that older patients or those with ET-related disabilities have access to optimal diagnosis and treatment.</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflict of interests</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interests in relation to this article.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Description and epidemiology of endocrine tumors" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Complexity of endocrine tumors" ] 3 => array:3 [ "identificador" => "sec0020" "titulo" => "Multidisciplinary healthcare models" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Limitation of traditional models" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Multidisciplinary care concept" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Advantages" ] 3 => array:2 [ "identificador" => "sec0040" "titulo" => "Structure and roles" ] ] ] 4 => array:3 [ "identificador" => "sec0045" "titulo" => "Hospital Ramón y Cajal Endocrine Tumor Board" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Definition and objectives" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Structure and operation" ] 2 => array:2 [ "identificador" => "sec0060" "titulo" => "Responsibilities" ] 3 => array:2 [ "identificador" => "sec0065" "titulo" => "Activities" ] ] ] 5 => array:2 [ "identificador" => "sec0070" "titulo" => "Options for improvement" ] 6 => array:2 [ "identificador" => "sec0075" "titulo" => "Conflict of interests" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-10-21" "fechaAceptado" => "2014-12-11" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Díez JJ, Grande E, Alonso T, Iglesias P. Abordaje multidisciplinar en el diagnóstico y tratamiento de pacientes con tumores endocrinos. Med Clin (Barc). 2015;145:36–41.</p>" ] ] "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2696 "Ancho" => 3249 "Tamanyo" => 546439 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Location of the main endocrine tumors.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Incidence (per 100,000 per year) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Prevalence (per 100,000) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reference \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Parathyroid tumors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20–75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100–700 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Wermers et al.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">1</span></a> (1997), Adami et al.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">2</span></a> (2002), Yu et al.<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">3</span></a> (2009) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Thyroid cancer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.6–8.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35–128 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Rego-Iraeta et al.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">4</span></a> (2009) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pituitary tumors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77.6–94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Golden et al.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">5</span></a> (2009), Fernández et al.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">6</span></a> (2010), Daly et al.<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">7</span></a> (2006) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neuroendocrine tumors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1–5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">∼35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Modlin et al.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">8</span></a> (2003), Pape et al.<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">9</span></a> (2004), Yao et al.<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">10</span></a> (2007), Yao et al.<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">11</span></a> (2008) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pheochromocytoma-paraganglioma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Beard et al.<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">12</span></a> (1983), Conzo et al.<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">13</span></a> (2014) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Adrenal cancer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1–0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Golden et al.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">5</span></a> (2009), Ng and Libertino<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">14</span></a> (2003) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab990789.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Incidence and prevalence of some endocrine tumors.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">CT: computerised tomography; DMSA-V: pentavalent dimercaptosuccinic acid; DOPA: dihydroxyphenylalanine; DOTA: 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid; FDG: fluorodeoxyglucose; FNAB: fine-needle aspiration biopsy; MIBG: metaiodobenzylguanidine; NOC: Nal<span class="elsevierStyleSup">3</span>-octreotide; PET: positron emission tomography; SPECT: single-photon emission tomography; SS: somatostatin; TATE: Tyr<span class="elsevierStyleSup">3</span>-octreotate; TOC: Tyr<span class="elsevierStyleSup">3</span>-octreotide; 5-HTP: 5-hydroxytryptophan.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Biochemical tests \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Radiological techniques \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Nuclear medicine techniques \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Other techniques \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Hormone tests</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Conventional radiology</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Scintigraphies</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Endoscopic procedures</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pituitary hormones \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Multiphase/multidetector CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SS-receptor scintigraphy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Upper gastrointestinal endoscopy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Thyroid hormones \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Magnetic resonance imaging \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">MIBG scintigraphy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Capsule endoscopy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Calcium and phosphate metabolism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Barium studies \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">DMSA-V scintigraphy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Colonoscopy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Adrenal hormones \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Interventional radiology</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Screening with <span class="elsevierStyleSup">131</span>I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fibreoptic bronchoscopy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pancreatic hormones \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Venous catheterisation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SPECT and SPECT-CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Thoracoscopy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Gastrointestinal hormones \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Artery catheterisation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">PET-CT</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mediastinoscopy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Tumor markers</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Ultrasound</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleSup">18</span>F-FDG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">FNAB</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Thyroglobulin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Transcutaneous ultrasound \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleSup">11</span>C-L-DOPA, <span class="elsevierStyleSup">18</span>F-L-DOPA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Thyroids \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Calcitonin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Endoscopic ultrasound \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleSup">11</span>C-5-HTP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Liver \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Carcinoembryonic antigen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Intraoperative ultrasound \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleSup">68</span>Ga-DOTA-NOC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Other organs \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Chromogranin A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Endoanal ultrasound \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleSup">68</span>Ga-DOTA-TOC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Histological markers</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Neuron-specific enolase \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleSup">68</span>Ga-DOTA-TATE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Immunohistochemistry \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>5-Hydroxyindoleacetic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleSup">90</span>Y-DOTA-TOC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ki-67 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleSup">68</span>Ga-DOTA-exendin 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab990792.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Complexity of diagnostic procedures used in patients with endocrine tumors.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Improve patient care \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Reduce morbidity and mortality \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Improve patient satisfaction and quality of life \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Increase coordination among departments \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Select diagnostic procedures with the highest yield \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Provide access to the most suitable evidence-based treatments \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Improve research opportunities \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Reduce costs \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab990788.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Multidisciplinary team objectives.</p>" ] ] 4 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Improvements in processes</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Better diagnostic procedures \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Better tumor staging \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Less clinical variability \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Easier enrolment of patients in clinical trials and research studies \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Improvements in results</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Less time from diagnosis to start of treatment \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Better choice of treatment \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Better medical and surgical outcomes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Increased patient, physician and institutional satisfaction \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Better survival rates compared to traditional healthcare \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab990790.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Advantages of healthcare through multidisciplinary teams.</p>" ] ] 5 => array:7 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Opportunities \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Challenges \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Training of new experts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Relatively low frequency of endocrine tumors \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Continuous professional development \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lack of teamwork culture \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Development of registries and databases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Reluctance of some departments to a cross-disciplinary vision \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Promotion of national and international partnerships \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Excessive caseloads for team members \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Greater availability of uncommon treatments \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lack of motivation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">More patients treated \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lack of incentives \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Wider array of diagnostic and therapeutic procedures \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Administrative barriers \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Increased care needs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab990793.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Opportunities and challenges for multidisciplinary teams in the care of patients with endocrine tumors.</p>" ] ] 6 => array:7 [ "identificador" => "tbl0030" "etiqueta" => "Table 6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Achieve the maximum level of scientific and technical quality in the healthcare provided to patients with endocrine tumors \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Establish patient flows that optimise resources and improve treatment times in patients with endocrine tumors \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Develop the diagnostic and therapeutic aspects of the hospital's endocrine tumor speciality service \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Advise hospital management on all issues related to the endocrine tumor speciality service \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab990791.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Objectives of the Hospital Ramón y Cajal Endocrine Tumor Board.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:50 [ 0 => array:3 [ "identificador" => "bib0255" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The rise and fall of primary hyperparathyroidism: a population-based study in Rochester, Minnesota, 1965–1992" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R.A. Wermers" 1 => "S. Khosla" 2 => "E.J. Atkinson" 3 => "S.F. Hodgson" 4 => "W.M. O’Fallon" 5 => "L.J. Melton 3rd" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "1997" "volumen" => "126" "paginaInicial" => "433" "paginaFinal" => "440" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9072928" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0260" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of primary hyperparathyroidism in Europe" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Adami" 1 => "C. Marcocci" 2 => "D. 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Journal Information
Vol. 145. Issue 1.
Pages 36-41 (July 2015)
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Vol. 145. Issue 1.
Pages 36-41 (July 2015)
Special article
Multidisciplinary approach in the diagnosis and therapy of patients with endocrine tumors
Abordaje multidisciplinar en el diagnóstico y tratamiento de pacientes con tumores endocrinos
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Table 2. Complexity of diagnostic procedures used in patients with endocrine tumors.
Table 3. Multidisciplinary team objectives.
Table 4. Advantages of healthcare through multidisciplinary teams.
Table 5. Opportunities and challenges for multidisciplinary teams in the care of patients with endocrine tumors.
Table 6. Objectives of the Hospital Ramón y Cajal Endocrine Tumor Board.
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