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1.
Front Public Health ; 12: 1335265, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38779422

RESUMO

Goal: To describe the experience of a dispensing model of outpatient hospital medicines (OHM) via collaboration of hospital and community pharmacies, and to explore patient satisfaction with the strategy as compared with the hospital pharmacy only service. Background: Patient satisfaction is an important component of the quality of health care. Study: A new model of dispensing OHM was conducted in the Outpatients Unit of the Service of Hospital Pharmacy of Hospital del Mar, in Barcelona, Spain. Participants were patients on stable chronic treatment with clinical or social fragility, immunocompromised patients, and those whose residence was located at a distance from the hospital that justified drug delivery through the community pharmacy. A cross sectional study was done using an ad hoc 14-item questionnaire collecting demographic data, duration of treatment, usual mode of collecting medication, and the degree of satisfaction regarding waiting time for the collection of medication, attention received by professionals, information received on treatment, and confidentiality. Results: The study population included a total of 4,057 patients (66.8% men) with a mean age of 53 (15.5) years, of whom 1,286 responded, with a response rate of 31.7%. Variables significantly associated with response to the survey were age over 44 years, particularly the age segment of 55-64 years (odds ratio [OR] 2.51) and receiving OHM via the community pharmacy (OR 12.76). Patients in the community pharmacy group (n = 927) as compared with those in the hospital pharmacy group (n = 359) showed significantly higher percentages of 'satisfied' and 'very satisfied' (p < 0.001) in the waiting time for the collection of OHM (88.1% vs. 66%), attention received by professionals (92.5% vs. 86.1%), and information received on treatment (79.4% vs. 77.4%). In relation to confidentiality, results obtained were similar in both pharmacy settings. Conclusion: Dispensing OHM through the community pharmacy was a strategy associated with greater patient satisfaction as compared with OHM collection at the hospital pharmacy service, with greater accessibility, mainly due to close distance to the patient's home. The participation of community pharmacists could further optimize the care received by patients undergoing OHM treatment.


Assuntos
Satisfação do Paciente , Serviço de Farmácia Hospitalar , Humanos , Estudos Transversais , Masculino , Pessoa de Meia-Idade , Feminino , Satisfação do Paciente/estatística & dados numéricos , Adulto , Inquéritos e Questionários , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Espanha , Idoso , Serviços Comunitários de Farmácia/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos
2.
Womens Health Rep (New Rochelle) ; 5(1): 319-323, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38596479

RESUMO

Pregnant women with p phenotype, who lack antigens P, P1, and Pk, spontaneously form anti-PP1Pk antibodies whose primary target is the placenta. The risk of miscarriage in these women is 50%-70% and reaches 87% in the second trimester. The therapies aim to reduce the titer of antibodies early in pregnancy. They also have risk of hemolytic transfusion reaction, with very few compatible red blood cell donors in the world. In this study, we present a case of successful pregnancy managed with autologous blood donations and plasmapheresis.

3.
Front Nutr ; 11: 1327301, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38379551

RESUMO

The aims of this proof of principle study were to compare two different chemometric approaches using a Bayesian method, Partial Least Square (PLS) and PLS-discriminant analysis (DA), for the prediction of the chemical composition and texture properties of the Grana Padano (GP) and Parmigiano Reggiano (PR) PDO cheeses by using NIR and Raman spectra and quantify their ability to distinguish between the two PDO and among their ripening periods. For each dairy chain consortium, 9 cheese samples from 3 dairy industries were collected for a total of 18 cheese samples. Three seasoning times were chosen for each dairy industry: 12, 20, and 36 months for GP and 12, 24, and 36 months for PR. A portable NIR instrument (spectral range: 950-1,650 nm) was used on 3 selected spots on the paste of each cheese sample, for a total of 54 spectra collected. An Alpha300 R confocal Raman microscope was used to collect 10 individual spectra for each cheese sample in each spot for a total of 540 Raman spectra collected. After the detection of eventual outliers, the spectra were also concatenated together (NIR + Raman). All the cheese samples were assessed in terms of chemical composition and texture properties following the official reference methods. A Bayesian approach and PLS-DA were applied to the NIR, Raman, and fused spectra to predict the PDO type and seasoning time. The PLS-DA reached the best performances, with 100% correctly identified PDO type using Raman only. The fusion of the data improved the results in 60% of the cases with the Bayesian and of 40% with the PLS-DA approach. A Bayesian approach and a PLS procedure were applied to the NIR, Raman, and fused spectra to predict the chemical composition of the cheese samples and their texture properties. In this case, the best performance in validation was reached with the Bayesian method on Raman spectra for fat (R2VAL = 0.74). The fusion of the data was not always helpful in improving the prediction accuracy. Given the limitations associated with our sample set, future studies will expand the sample size and incorporate diverse PDO cheeses.

4.
J Clin Med ; 10(21)2021 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-34768404

RESUMO

No therapies have been proven to increase survival after a hepatic encephalopathy (HE) episode. We hypothesize that two doses of albumin could improve 90-day survival rates after a HE episode. METHODS: (1) A randomized double-blind, placebo-controlled trial (BETA) was conducted in 12 hospitals. The effect of albumin (1.5 g/kg at baseline and 1 g/kg on day 3) on 90-day survival rates after a HE episode grade II or higher was evaluated. (2) A meta-analysis of individual patient's data for survival including two clinical trials (BETA and ALFAE) was performed. RESULTS: In total, 82 patients were included. Albumin failed to increase the 90-day transplant-free survival (91.9% vs. 80.5%, p = 0.3). A competing risk analysis was performed, observing a 90-day cumulative incidence of death of 9% in the albumin group vs. 20% in the placebo (p = 0.1). The meta-analysis showed a benefit in the albumin group, with a lower rate of clinical events (death or liver transplant) than patients in the placebo (HR, 0.44; 95% CI, 0.21-0.82), when analyzed by a competing risk analysis (90-days mortality rate of 11% in the albumin group vs. 30% in the placebo, p = 0.02). CONCLUSIONS: Repeated doses of albumin might be beneficial for patient's survival as an add-on therapy after an HE episode, but an adequately powered trial is needed.

5.
Sci Rep ; 9(1): 13355, 2019 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-31527825

RESUMO

A mass mortality event is devastating the populations of the endemic bivalve Pinna nobilis in the Mediterranean Sea from early autumn 2016. A newly described Haplosporidian endoparasite (Haplosporidium pinnae) is the most probable cause of this ecological catastrophe placing one of the largest bivalves of the world on the brink of extinction. As a pivotal step towards Pinna nobilis conservation, this contribution combines scientists and citizens' data to address the fast- and vast-dispersion and prevalence outbreaks of the pathogen. Therefore, the potential role of currents on parasite expansion was addressed by means of drift simulations of virtual particles in a high-resolution regional currents model. A generalized additive model was implemented to test if environmental factors could modulate the infection of Pinna nobilis populations. The results strongly suggest that the parasite has probably dispersed regionally by surface currents, and that the disease expression seems to be closely related to temperatures above 13.5 °C and to a salinity range between 36.5-39.7 psu. The most likely spread of the disease along the Mediterranean basin associated with scattered survival spots and very few survivors (potentially resistant individuals), point to a challenging scenario for conservation of the emblematic Pinna nobilis, which will require fast and strategic management measures and should make use of the essential role citizen science projects can play.


Assuntos
Bivalves/parasitologia , Surtos de Doenças/veterinária , Haplosporídios/crescimento & desenvolvimento , Infecções Protozoárias em Animais/epidemiologia , Animais , Ecossistema , Meio Ambiente , Haplosporídios/classificação , Mar Mediterrâneo/epidemiologia , Filogenia , Infecções Protozoárias em Animais/parasitologia , Salinidade , Temperatura
6.
Acta Trop ; 177: 194-199, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29042261

RESUMO

The first record of Triatoma lecticularia out of its reported distribution area together with the brief description of the said area is provided in this paper. In addition, some biological parameters related to hatching of eggs, life cycle and feeding and defecation behaviors for each instar of one population of T. lecticularia from its previously reported distribution area (PR) and for each instar of that introduced recently found population (IS) of this species were evaluated and compared. Twenty-eight specimens were collected from IS, mostly (64.29%) from peridomestic areas (mainly chicken coops). No significant (p>0.05) differences were recorded between the two studied cohorts in their average time to hatch, which was close to 19days. The median egg-to-adult development time, the number of blood meals at each nymphal, the instar mortality rates and median time-lapse for beginning of feeding were significantly (p<0.05) shorter for the IS cohort. Median feeding time was higher in PR. Defecation delay was shorter than 10min in both studied cohorts. Given these results, the introduced recently found population of T. lecticularia could be considered an important potential vector of Trypanosoma cruzi to human populations and could replace main triatomine species on its new distribution area.


Assuntos
Doença de Chagas/transmissão , Comportamento Alimentar/fisiologia , Insetos Vetores/fisiologia , Espécies Introduzidas , Estágios do Ciclo de Vida/fisiologia , Ninfa/fisiologia , Triatoma/crescimento & desenvolvimento , Animais , Vetores de Doenças , Humanos , México
7.
Gastroenterol Hepatol ; 39(9): 607-626, 2016 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-26778768

RESUMO

Cirrhotic patients often develop severe complications requiring ICU admission. Grade III-IV hepatic encephalopathy, septic shock, acute-on-chronic liver failure and variceal bleeding are clinical decompensations that need a specific therapeutic approach in cirrhosis. The increased effectiveness of the treatments currently used in this setting and the spread of liver transplantation programs have substantially improved the prognosis of critically ill cirrhotic patients, which has facilitated their admission to critical care units. However, gastroenterologists and intensivists have limited knowledge of the pathogenesis, diagnosis and treatment of these complications and of the prognostic evaluation of critically ill cirrhotic patients. Cirrhotic patients present alterations in systemic and splanchnic hemodynamics, coagulation and immune dysfunction what further increase the complexity of the treatment, the risk of developing new complications and mortality in comparison with the general population. These differential characteristics have important diagnostic and therapeutic implications that must be known by general intensivists. In this context, the Catalan Society of Gastroenterology and Hepatology requested a group of experts to draft a position paper on the assessment and treatment of critically ill cirrhotic patients. This article describes the recommendations agreed upon at the consensus meetings and their main conclusions.


Assuntos
Estado Terminal , Cirrose Hepática/terapia , Injúria Renal Aguda/etiologia , Antibacterianos/uso terapêutico , Transtornos da Coagulação Sanguínea/etiologia , Terapia Combinada , Cuidados Críticos/métodos , Gerenciamento Clínico , Diagnóstico Precoce , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/terapia , Hidratação , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Técnicas Hemostáticas , Encefalopatia Hepática/etiologia , Encefalopatia Hepática/terapia , Humanos , Cirrose Hepática/complicações , Falência Hepática/etiologia , Falência Hepática/terapia , Transplante de Fígado , Respiração Artificial , Choque Séptico/etiologia , Choque Séptico/terapia
8.
PLoS One ; 10(5): e0125085, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25961562

RESUMO

Models of social influence have explored the dynamics of social contagion, imitation, and diffusion of different types of traits, opinions, and conducts. However, few behavioral data indicating social influence dynamics have been obtained from direct observation in "natural" social contexts. The present research provides that kind of evidence in the case of the public expression of political preferences in the city of Barcelona, where thousands of citizens supporting the secession of Catalonia from Spain have placed a Catalan flag in their balconies and windows. Here we present two different studies. 1) During July 2013 we registered the number of flags in 26% of the electoral districts in the city of Barcelona. We find that there is a large dispersion in the density of flags in districts with similar density of pro-independence voters. However, by comparing the moving average to the global mean we find that the density of flags tends to be fostered in electoral districts where there is a clear majority of pro-independence vote, while it is inhibited in the opposite cases. We also show that the distribution of flags in the observed districts deviates significantly from that of an equivalent random distribution. 2) During 17 days around Catalonia's 2013 national holiday we observed the position at balcony resolution of the flags displayed in the facades of a sub-sample of 82 blocks. We compare the 'clustering index' of flags on the facades observed each day to thousands of equivalent random distributions. Again we provide evidence that successive hangings of flags are not independent events but that a local influence mechanism is favoring their clustering. We also find that except for the national holiday day the density of flags tends to be fostered in facades located in electoral districts where there is a clear majority of pro-independence vote.


Assuntos
Política , Espanha
9.
J Hepatol ; 60(5): 955-61, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24447876

RESUMO

BACKGROUND & AIMS: Terlipressin and albumin is the standard of care for classical type-1 hepatorenal syndrome (HRS) not associated with active infections. However, there is no information on efficacy and safety of this treatment in patients with type-1 HRS associated with sepsis. Study aim was to investigate the effects of early treatment with terlipressin and albumin on circulatory and kidney function in patients with type-1 HRS and sepsis and assess factors predictive of response to therapy. METHODS: Prospective study in 18 consecutive patients with type-1 HRS associated with sepsis. RESULTS: Treatment was associated with marked improvement in arterial pressure and suppression of the high levels of plasma renin activity and norepinephrine. Response to therapy (serum creatinine <1.5mg/dl) was achieved in 12/18 patients (67%) and was associated with improved 3-month survival compared to patients without response. Non-responders had significantly lower baseline heart rate, poor liver function tests, slightly higher serum creatinine, and higher Child-Pugh and MELD scores compared to responders. Interestingly, non-responders had higher values of CLIF-SOFA score compared to responders (14±3 vs. 8±1, respectively p<0.001), indicating greater severity of acute-on-chronic liver failure (ACLF). A CLIF-SOFA score ⩾11 had 92% sensitivity and 100% specificity in predicting no response to therapy. No significant differences were observed between responders and non-responders in baseline urinary kidney biomarkers. Treatment was safe and no patient required withdrawal of terlipressin. CONCLUSIONS: Early treatment with terlipressin and albumin in patients with type-1 HRS associated with sepsis is effective and safe. Patients with associated severe ACLF are unlikely to respond to treatment.


Assuntos
Albuminas/uso terapêutico , Síndrome Hepatorrenal/complicações , Síndrome Hepatorrenal/tratamento farmacológico , Lipressina/análogos & derivados , Sepse/complicações , Idoso , Pressão Sanguínea , Creatinina/sangue , Feminino , Frequência Cardíaca , Síndrome Hepatorrenal/fisiopatologia , Humanos , Rim/fisiopatologia , Falência Hepática/complicações , Falência Hepática/tratamento farmacológico , Falência Hepática/fisiopatologia , Lipressina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sepse/tratamento farmacológico , Terlipressina , Resultado do Tratamento
10.
Med Oral Patol Oral Cir Bucal ; 19(1): e49-54, 2014 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-24121915

RESUMO

OBJECTIVES: The aim of this study is to compare the analgesic and anti-inflammatory effects of the local postoperative administration of a single 12-mg dose of betamethasone after the surgical removal of impacted lower third molars. STUDY DESIGN: A split-mouth, triple-blind, randomized, placebo-controlled clinical trial of 25 patients requiring the surgical removal of symmetrical lower third molars was performed. In the experimental side, a 12-mg dose of betamethasone was administered submucosally after the surgical procedure, while in the control side a placebo (sterile saline solution) was injected in the same area. To assess postoperative pain, visual analogue scales and the consumption of rescue analgesic were used. The facial swelling and trismus were evaluated by measuring facial reference distances and maximum mouth opening. RESULTS: There were no significant differences between the two study groups regarding postoperative pain, facial swelling and trismus. CONCLUSIONS: The injection of a single dose of betamethasone does not seem to reduce pain, facial swelling and trismus after impacted lower third molar removal when compared to placebo.


Assuntos
Analgésicos/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Betametasona/administração & dosagem , Edema/prevenção & controle , Dente Serotino/cirurgia , Dor Pós-Operatória/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Extração Dentária , Dente Impactado/cirurgia , Trismo/prevenção & controle , Administração Tópica , Método Duplo-Cego , Feminino , Humanos , Masculino , Estudos Prospectivos , Adulto Jovem
12.
Sensors (Basel) ; 12(2): 1509-28, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22438723

RESUMO

This paper introduces a flexible hardware and software architecture for a smart video sensor. This sensor has been applied in a video surveillance application where some of these video sensors are deployed, constituting the sensory nodes of a distributed surveillance system. In this system, a video sensor node processes images locally in order to extract objects of interest, and classify them. The sensor node reports the processing results to other nodes in the cloud (a user or higher level software) in the form of an XML description. The hardware architecture of each sensor node has been developed using two DSP processors and an FPGA that controls, in a flexible way, the interconnection among processors and the image data flow. The developed node software is based on pluggable components and runs on a provided execution run-time. Some basic and application-specific software components have been developed, in particular: acquisition, segmentation, labeling, tracking, classification and feature extraction. Preliminary results demonstrate that the system can achieve up to 7.5 frames per second in the worst case, and the true positive rates in the classification of objects are better than 80%.


Assuntos
Redes de Comunicação de Computadores/instrumentação , Interpretação de Imagem Assistida por Computador/instrumentação , Reconhecimento Automatizado de Padrão/métodos , Fotografação/instrumentação , Medidas de Segurança , Transdutores , Gravação em Vídeo/instrumentação , Inteligência Artificial , Desenho de Equipamento , Análise de Falha de Equipamento , Software
13.
Gastroenterol Hepatol ; 34(9): 599-604, 2011 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-22037093

RESUMO

INTRODUCTION: Because of the current overload of emergency services, new units, such as day units, have had to be created. Liver cirrhosis (LC) is a chronic disease with frequent decompensations requiring medical attention. The aim of this study was to compare differences between emergency consultations in a hepatology day hospital (HDH) and in an emergency service (ES) among patients with LC. METHODS AND MATERIAL: We performed an observational prospective study. All patients with LC attending the HDH or ES from September 2007 to August 2008 were asked to complete a questionnaire. Demographic, clinical, and radiological variables were collected. RESULTS: There were 743 consultations, of which 62% involved the HDH. The mean age was 65±12 years, and the male/female ratio was 2:3. The most frequent diagnosis in the ES was hepatic encephalopathy (26.2% ES versus 6% HDH, p<0.001) followed by upper gastrointestinal hemorrhage (17.7% ES versus 0.6% HDH, p<0.001), while the most frequent diagnosis in the HDH was ascites (66.2% HDH versus 22.7% ES, p<0.001). The tests performed were as follows: blood analysis: 95% ES versus 60% HDH (p<0.01); radiology: 71% ES versus 11% HDH (p<0.01) and paracentesis: 51% ES versus 74% HDH (p<0.01). The mean length of stay in the ES was 21.3±121.5 hours compared with 3.3±2.4 hours in the HDH (p<0.001). A total of 53% of patients attended in the ES were hospitalized compared with 12% of those attended in the HDH (p<0.05). CONCLUSION: Patients with LC preferentially attend the HDH, where fewer tests are performed and the length of stay is shorter. The care provided in the HDH is appropriate and efficient.


Assuntos
Hospital Dia/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Cirrose Hepática , Idoso , Feminino , Gastroenterologia , Hospitais Especializados , Humanos , Cirrose Hepática/terapia , Masculino , Estudos Prospectivos
14.
Rev Panam Salud Publica ; 27(1): 49-55, 2010 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-20209232

RESUMO

OBJECTIVES: To evaluate the results of implementing a classification system based on adjusted clinical groups (ACG) at a primary health care (PHC) in a Spanish population. METHODS: A retrospective, cross-sectional study based on the computerized medical records of outpatients seen in 2007 by the La Roca clinic, administered by a health services management company in La Roca del Vallès, Barcelona, Spain. The ACGs were formed according to the International Classification of Diseases, 9th Revision, Clinical Modification. The relative weight of each ACG's total average cost was calculated (in U.S. dollars) and based on these, the resources usage levels were established. The risk index (RI) and efficiency index (EI) for 2006 and the classification's explanatory power were determined. RESULTS: A total of 8 294 patients were studied (82.7% coverage), with an average of 4.1 incidents per patient, 6.9 visits per patient, and 5.7 visits per person per year. Seven GCAs accounted for 51.0% of patients seen. The RI was 1.015, the EI was 0.975 visits, and the explanatory power of the ACG classification was 53.4% for visits and 74.8% for incidents. CONCLUSIONS: The ACG system allowed this patient population to be grouped by clinical status, which can help to, among other things, allocate resources and evaluate PHC team efficiency.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Grupos Diagnósticos Relacionados , Classificação Internacional de Doenças , Atenção Primária à Saúde , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Prontuários Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Visita a Consultório Médico/estatística & dados numéricos , Estudos Retrospectivos , Risco , Espanha/epidemiologia , População Urbana , Adulto Jovem
15.
Rev. panam. salud pública ; 27(1): 49-55, jan. 2010. graf, tab
Artigo em Espanhol | LILACS | ID: lil-577024

RESUMO

OBJETIVOS: Evaluar los resultados de la aplicación del sistema de clasificación mediante grupos clínicos ajustados (GCA) en un centro de atención primaria de salud (APS) de una población española. MÉTODOS: Estudio transversal retrospectivo a partir de los registros médicos informatizados de los pacientes atendidos ambulatoriamente durante 2007 en el centro de salud La Roca, administrado por una empresa de gestión de servicios de salud en La Roca del Vallès, Barcelona, España. Los GCA se conformaron según la Clasificación Internacional de Enfermedades, 9.ª revisión, modificación clínica. Se calcularon los pesos relativos medios en dólares estadounidenses de cada GCA respecto al costo medio total y, a partir de ellos, se crearon las bandas de utilización de recursos. Se determinaron los índices de riesgo (IR) y eficiencia (IE) con respecto a 2006 y se estimó el poder explicativo de la clasificación empleada. RESULTADOS: Se estudiaron 8 294 pacientes, para una cobertura de 82,7 por ciento, con una media de 4,1 episodios por paciente, 6,9 visitas por paciente y 5,7 visitas por habitante al año. A siete GCA correspondió 51,0 por ciento de los pacientes atendidos. El IR fue de 1,015, el IE en las visitas de 0,975 y el poder explicativo de la clasificación en GCA fue de 53,4 por ciento para las visitas y de 74,8 por ciento para los episodios. CONCLUSIONES: El sistema de GCA permitió agrupar a los pacientes de una población según su estado clínico y puede ayudar, entre otros aspectos, en la asignación de recursos y la evaluación de la eficiencia de los equipos de APS.


OBJECTIVES: To evaluate the results of implementing a classification system based on adjusted clinical groups (ACG) at a primary health care (PHC) in a Spanish population. METHODS: A retrospective, cross-sectional study based on the computerized medical records of outpatients seen in 2007 by the La Roca clinic, administered by a health services management company in La Roca del Vallès, Barcelona, Spain. The ACGs were formed according to the International Classification of Diseases, 9th Revision, Clinical Modification. The relative weight of each ACG's total average cost was calculated (in U.S. dollars) and based on these, the resources usage levels were established. The risk index (RI) and efficiency index (EI) for 2006 and the classification's explanatory power were determined. RESULTS: A total of 8 294 patients were studied (82.7 percent coverage), with an average of 4.1 incidents per patient, 6.9 visits per patient, and 5.7 visits per person per year. Seven GCAs accounted for 51.0 percent of patients seen. The RI was 1.015, the EI was 0.975 visits, and the explanatory power of the ACG classification was 53.4 percent for visits and 74.8 percent for incidents. CONCLUSIONS: The ACG system allowed this patient population to be grouped by clinical status, which can help to, among other things, allocate resources and evaluate PHC team efficiency.


Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Instituições de Assistência Ambulatorial , Grupos Diagnósticos Relacionados , Classificação Internacional de Doenças , Atenção Primária à Saúde , Estudos Transversais , Prontuários Médicos/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Estudos Retrospectivos , Risco , Espanha/epidemiologia , População Urbana , Adulto Jovem
16.
Curr Med Res Opin ; 25(10): 2533-42, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19722781

RESUMO

BACKGROUND: Febrile neutropenia (FN) is associated with disruption of planned chemotherapy and increased management costs. However, the economic impact of FN in Spanish clinical practice has not been documented hitherto. RESEARCH DESIGN AND METHODS: A multicenter, retrospective chart review of adults with breast or lung cancer or non-Hodgkin's lymphoma (NHL) who had > or = 1 FN episode during chemotherapy. Resource use, direct costs, and FN effect on planned chemotherapy were assessed. MAIN OUTCOME MEASURES: 238 episodes of FN were analyzed in 194 patients. The mean + or - SD length of FN-related hospitalization was 8.7 + or - 6.9 days (median [p(25)-p(75)] = 7 [5-11] days). At least one transfusion was needed in 77 (32.3%) FN episodes, blood tests were done in 233 (97.9%) and blood cultures in 207 (87.0%). Antibiotics were used in all episodes (100%), other drugs in 186 (78.2%) episodes and the granulocyte colony-stimulating factor (G-CSF) in 161 (67.7%) episodes. The distribution of costs per episode of FN were: hospitalization 79%, antibiotics 10%, G-CSF 5%, complementary tests 4%; other drugs 1%, blood transfusions 1%. The estimated mean (95% CI) cost per FN episode was euro3841 (95% CI: euro3476-4206). FN management was costlier in NHL patients euro4514 (95% CI: euro3805-5223) than in breast or lung cancer patients (euro3519 [95% CI: euro2976-4061] and euro3311 [95% CI: euro2817-3805] respectively) (P < 0.05 both comparisons). Planned chemotherapy was disrupted in 139 (58.4%) episodes (dose reductions in 75 [34.9%], dose delays in 60 [28.0%] and withdrawal in 33 [14.7%]). CONCLUSIONS: FN substantially affects healthcare resource use and costs in breast cancer, lung cancer and, NHL. In this study, hospitalization and antibiotics were the main drivers of cost. A limitation of the analysis was that it did not include the indirect costs associated with FN episodes.


Assuntos
Antineoplásicos/efeitos adversos , Custos e Análise de Custo , Febre/economia , Neoplasias/tratamento farmacológico , Neutropenia/economia , Adulto , Idoso , Feminino , Febre/induzido quimicamente , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Neutropenia/induzido quimicamente , Estudos Retrospectivos , Espanha
17.
Ann Hematol ; 88(8): 769-73, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19159929

RESUMO

Monoclonal gammopathy of unknown significance (MGUS) is a chronic haematological alteration that carries a 1% risk per year of malignant evolution. The origin of this disturbance remains unknown. Previous reports have suggested that a subgroup of patients presenting MGUS might cure after Helicobacter pylori eradication. This study evaluates the effect of H. pylori eradication in a cohort of 30 patients with MGUS. A 7-day clarithromycin-based triple treatment was prescribed to patients with MGUS infected with H. pylori. Quantification of the monoclonal component was performed at inclusion and at least 12 months after treatment. The monoclonal component persisted unchanged in all patients who cured the H. pylori infection.


Assuntos
Claritromicina/administração & dosagem , Helicobacter pylori/efeitos dos fármacos , Gamopatia Monoclonal de Significância Indeterminada/imunologia , Gamopatia Monoclonal de Significância Indeterminada/virologia , Paraproteínas/análise , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Gamopatia Monoclonal de Significância Indeterminada/tratamento farmacológico , Estudos Prospectivos , Reprodutibilidade dos Testes , Resultado do Tratamento
18.
Value Health ; 12(1): 130-8, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-18647250

RESUMO

OBJECTIVES: Existing instruments that measure the impact of cancer-related fatigue on health-related quality of life do not usually incorporate the attitudes, beliefs and perspectives of patients. This study aimed to develop an instrument to measure the impact of cancer-related fatigue on the health-related quality of life of cancer patients. METHODS: Items were generated from a literature review, focus groups of cancer patients and meetings with oncologists. Potential items were administered to cancer patients to facilitate item reduction, which was based on clinimetric and psychometric analyses and qualitative criteria. A preliminary assessment of feasibility, reliability and validity of the retained items was performed. RESULTS: An initial pool of 75 items was administered to 238 cancer patients. Fifty items were eliminated after statistical analysis and 13 in response to expert opinion, resulting in a provisional instrument with 12 items in 3 dimensions. These displayed acceptable internal consistency (Cronbach's alpha, 0.78-0.92) and their overall score was associated with fatigue intensity, extent of disease, intention of treatment and need of caregivers. CONCLUSION: The newly developed questionnaire, which measures the impact of cancer-related fatigue on oncology patients, has shown satisfactory feasibility, reliability and validity.


Assuntos
Atitude Frente a Saúde , Fadiga/psicologia , Neoplasias/psicologia , Inquéritos e Questionários , Fadiga/complicações , Fadiga/etiologia , Feminino , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Qualidade de Vida
19.
Reumatol Clin ; 5(1): 13-7, 2009 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-21794568

RESUMO

AIM: To describe the treatment prescribed to osteopenic women seen at an urban primary health care centre and the treatment compliance of those patients with a prescription of calcium and/or vitamin D. MATERIALS AND METHOD: Cross-sectional study, osteopenic women diagnosed by bone densitometry between February 2005 and January 2006 (n=121). Clinical history review: demographic information; previous clinical history of bone fracture, type of fracture; parental history of fractures; tobacco use; osteoporosis-related medication or disease; dietary and sun exposure assessment; calcium, vitamin D and raloxiphene/bisphosphonates prescription; mean daily dose of calcium and vitamin D supplements collected at the pharmacy by patients. Analysis of treatment prescription and compliance according to the information collected was performed. RESULTS: Mean age, 61.9±9.1 years; 90.7% post-menopausic. The dietary assessment was performed in 30.5% of the women included in the study. The drug prescription was as follows: calcium 74.6%, vitamin D 68.6% and raloxiphene/bisphosphonates 16.1%. All drug prescriptions were associated with lower T-score values. The patient's compliance of calcium supplements has been calculated as mean of 423.8±321.7 mg/day, and 343.1±225.9 IU of vitamin D; with no association with any of the studied variables. CONCLUSIONS: We identified greater drug prescription in those patients with a lower T-score. The clinical history of previous fracture did not show association with drug prescription nor a better compliance. There was a lack of information about relevant issues in the clinical history of the osteopenic women included in the study. The patient's compliance of calcium and vitamin-D supplements is very variable.

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