A telephone support program for patients with home enteral nutrition contributes to nutrition status and quality of life maintenance and reduces health resource use.

BACKGROUND: Appropriate patient/caregiver training and continuity of care after hospital discharge are key factors for the success of home enteral nutrition (HEN). This study aims to assess the effects of a specific patient support program (PSP) on the nutrition status, health-related quality of life (HRQoL), and healthcare resource utilization and associated costs of patients with HEN. METHODS: Observational study of adult patients with HEN enrolled in a PSP. Sociodemographic variables (baseline), HRQoL (NutriQoL) and nutrition status (Mini Nutritional Assessment [MNA]) (baseline, 6 months after PSP enrollment), and use of unplanned HEN-related healthcare resources (6 months prior to or after PSP enrollment) were recorded. HEN-related resource cost was estimated from total resources used (all patients) and each resource cost. Data were analyzed with Stata program (v. 14), considering P < 0.05 as significant. RESULTS: Forty-three patients were included in the study (mean age, 72 years [SD = 21]; 54% women; mean HEN duration, 4 years [SD = 5]). A total of 401 calls were recorded in the PSP, 7% made proactively by the patient. HRQoL and nutrition status remained stable during the study period (NutriQoL baseline, 64; 6-months, 66; P = 0.3737; MNA baseline, 10; 6-months, 10; P = 0.0675). Unplanned resources amounted to €6229 (US $5563) and €4711 (US $4207) before and after PSP enrollment, respectively. Cost savings, representing €1518 (US $1356), were related to fewer emergency visits. CONCLUSIONS: Health advice provided through a PSP and close patient monitoring in the hospital can help to maintain patients' nutrition status and HRQoL and to reduce the use of certain unplanned HEN-related resources, leading to cost savings.

[Neurosurgery in the elderly patient: Geriatric neurosurgery]. / Neurocirugía en el paciente mayor: neurocirugía geriátrica.

OBJECTIVE: Between 2000 and 2050, the proportion of the world's population over 60 years will double, and the number of people aged 80 and older will quadruple. Health professional training does not include instructions about specific care for older people. The World Health Organization maintains that all health providers should be trained on ageing issues. Thus, it is proposed to analyse the effect of ageing on Neurosurgery in our country. MATERIAL AND METHOD: A retrospective historical cohort study was performed on individuals age 70 years or older admitted to the Neurosurgery or the Intensive Care Unit of our hospital, with neurosurgical disease, between two periods: 1999-2000 and 2010-2011. An analysis was made on variables such as: age, pathology, length of stay, comorbidity, performance status, re-admissions and mortality. RESULTS: Similar numbers of patients were admitted during the two periods: 409 and 413. However, there was an increase of 77.5% in patients older than 70 years: 80 versus 142. Statistically significant differences were observed in the Charlson Comorbidity Index, the admission Glasgow Coma Scale (GCS) score, length of stay, and re-admissions. Comorbidity and admission GCS score were particularly worse in the second period. Nevertheless, the mean length of stay was lower in that period, but showing more hospital re-admissions. After multivariate analysis, it was observed that re-admissions were associated with comorbidity, but not with early hospital discharge. No differences were found in performance status or mortality. CONCLUSIONS: A very considerable increase in percentage of patients older than 70 years old was found. There were no differences in performance status or mortality, which was probably due to the multidisciplinary management of these patients. The results of this study support the development of an interdisciplinary work group dedicated to Geriatric Neurosurgery.

[Reference population values of the Spanish version of the COOP/WONCA charts of quality of life in an urban adult population]. / Valores poblacionales de referencia de la versión española de las viñetas COOP/WONCA de calidad de vida en población adulta urbana.

BACKGROUND AND OBJECTIVE: We intended to obtain reference population values of the COOP/WONCA charts of health-related quality of life (HRQOL) among a Spanish urban adult population. MATERIAL AND METHOD: Cross sectional study based on data from the Survey of Health of the City of Madrid 2005. 7341 adults were selected by biphasic cluster sampling. The variable HRQOL was measured through COOP/WONCA charts of quality of life (9 dimensions), culturally validated for Spanish people. Other variables included age, sex, marital status, and social class, zone of origin and level of education. Statistical treatment included descriptive statistics for the dimensions and summation of HRQOL, significance tests (Kruskal-Wallis, Mann-Whitney, ANOVA), analysis of internal consistency and correlation. RESULTS: Highest mean values were found in the dimensions Changes in the State of Health, Health Status, Physical Form and Social Support. The average value of the dimensions and the summation of HRQOL increased significantly with age, and in parallel to a lowering of the social class and depending on the country of origin (higher in native people). They were also higher in women. The alpha of Cronbach for the questionnaire was 0.77. CONCLUSIONS: Reference population values were obtained for a Spanish urban adult population according to sex, age, social class and status of native or immigrant people. All ratings increased with age and were highest in women. The availability of benchmarks values contribute to the score' interpretation, which would ease the systematic use of tools of self-assessed health in clinical practice.

[How does intensive therapy of cardiovascular risk factors affect health-related quality of life in diabetic patients?]. / Cómo influye el tratamiento intensivo de los factores de riesgo cardiovascular en la calidad de vida relacionada con la salud de los pacientes diabéticos?

OBJECTIVE: To assess the health-related quality of life (HRQoL) in diabetic patients who have followed a protocol of intensive treatment of cardiovascular risks (CVR). DESIGN: Clinical trial randomised by cluster. A convenience sample of 65 primary care practitioners, randomly assigned to a control or intervention group. Patients were selected by systematic sampling from diabetic lists. The follow-up for the control group was by normal practice and the intervention group by using the intensive control of cardiovascular risk factors (CVRF) protocol. SETTING: Seventeen health-centres in the Valencia Community, Spain. PARTICIPANTS: One hundred and eighty-four patients, 93 in the control group and 91 in the intervention group. INCLUSION CRITERIA: patients diagnosed with diabetes mellitus (DM) type 2, aged between 45-75 years, DM for more than 2 years and less than 20 years and a cardiovascular risk (CVR) >20% after 10 years (Framingham equation). The exclusion criteria were: history of ischaemic heart disease, terminal illness, hepatic cirrhosis, renal failure, grade III-IV cardiac failure, and mental disorders. The patients self-completed the Spanish versions of the COOP/WONCA charts and a diabetes-specific tool (ADDQol questionnaire) at the start, and after 6 months and 12 months. MAIN MEASUREMENTS: Means of COOP/WONCA charts and ADDQol. Comparison between groups using Mann-Whitney U test, and the group follow ups using the Wilcoxon test. RESULTS: No significant differences were found in the COOP/WONCA charts. At 12 months the only significant difference was in the feelings chart (P=.024; control group 1.86+/-1.03: intervention group 2.23+/-1.11). A negative impact of diabetes was seen in all the dimensions of ADDQoL. The most negative impact of diabetes was related to diet. There were no significant differences between groups in the ADDQoL throughout the study. CONCLUSIONS: The HRQoL in diabetic patients is not affected by intensive therapy of cardiovascular risk factors. Diabetes has a negative impact on HRQoL in the patients studied.

[Initial treatment of patients with subjective memory complaints and/or cognitive impairment in primary care: ISSEA Study]. / Tratamiento inicial de los pacientes con quejas subjetivas de memoria y/o deterioro cognitivo en atención primaria: estudio ISSEA.

OBJECTIVE: To describe the initial treatment of patients >60 years who had subjective memory complaints and/or cognitive impairment for at least 6 months. DESIGN: Observational, longitudinal, multicentre, and naturalistic study, with a follow-up period of 12 months. SETTING: A total of 105 primary care centres. PARTICIPANTS: The study included 921 patients who attended a clinic. MAIN MEASUREMENTS: In the baseline visit, the social demographic characteristics, diagnosis, treatment, and the health care referrals were recorded, and in the next 2 (6 and 12 months) the diagnostic change, treatment, and referrals. RESULTS: The majority of subjects were female (66.9%) and the mean age was 74.3+/-6.8 years. In the initial visit, 50.5% (95% confidence interval [CI], 47.3-53.7) of the diagnoses were classed as syndromic and 33.3% (95% CI, 30.3-36.3), aetiological. The primary care doctor modified an unconfirmed initial diagnosis in 22% (95% CI, 19.3-24.7) of the patients during the 12 months follow-up study. A diagnosis was made in 63.8% (95% CI, 60.7-66.9) of patients by anamnesis, physical examination, the screening test, and laboratory data. In the initial visit, el 52.6% (95% CI, 49.4-55.8) received treatment of mainly nootropics and neuroprotectors, and later, the percentage of patients on cholinesterase inhibitors increased. The primary care doctor referred 54.9% (95% CI, 51.7-58.1) of the patients during the 12 months of the study. CONCLUSIONS: The primary care doctor diagnoses the majority of patients with the means available, mainly based on anamnesis, examination, the screening test, and laboratory data. They prescribe drugs that lack efficacy for this disease and few of those that have been shown to be effective.

[Impact of psoriasis on health-related quality of life]. / Impacto de la psoriasis en la calidad de vida relacionada con la salud.

BACKGROUND AND OBJECTIVE: Different studies have reported of physical, social and psychological disadvantages in patients with psoriasis. Nevertheless, its impact on the health-related quality of life is not clarified sufficiently. Our objective is to know the repercussion of the moderate-severe psoriasis on the health-related quality of life with the Psoriasis Disability Index (PDI). PATIENTS AND METHOD: An observational, cross-sectional, international study developed in dermatology practices in Spain and Portugal. During a period of 9 months, 332 participating dermatologist included a minimum of 10 consecutive patients with moderate to severe psoriasis. The date report form includes information about the health-related quality of life (PDI), as well as objective variables of severity as body surface area and PASI (Psoriasis Area and Severity Index), pruritus, costs and willingness to pay. RESULTS: A total of 3,320 patients were assessed. The majority of cases were males (57%) and the mean age at study inclusion time was 47 years. The mean value of the PDI was 8.93 (95% confidence interval, 7.83-9.21), which represents a percentage of global disability lower than 20%. The floor effect varies between 8.3% and 61.2%, and the ceiling effect varies between 0% and 3%. The correlations between the PDI and objective variables of severity (PASI and body surface area) were weak though statistically significant (p < 0.001) They all indicate that to higher severity of the psoriasis, upper negative impact in the health-related quality of life. CONCLUSIONS: Psoriasis causes a negative impact in the health-related quality of life, though the magnitudes are weak and suggest some problems with the questionnaire. Possibly, the PDI reflects more the disability that the form in which the patients perceive and react to their state of health, and, several items seem to have a scanty applicability in the Spanish and Portuguese population. The PDI doesn't seem the appropriate instrument for this type of patients in our environment.