Safety during the monitoring of diabetic patients: trial teaching course on health professionals and diabetics - SEGUDIAB study.

BACKGROUND: Safety for diabetic patients means providing the most suitable treatment for each type of diabetic in order to improve monitoring and to prevent the adverse effects of drugs and complications arising from the disease. The aim of this study is to analyze the effect of imparting educational interventions to health professionals regarding the safety of patients with Diabetes Mellitus (DM). DESIGN: A cluster randomized trial with a control group. SETTING AND SAMPLE: The study analyzed ten primary healthcare centres (PHC) covering approximately 150,000 inhabitants. Two groups of 5 PHC were selected on the basis of their geographic location (urban, semi-urban and rural), their socio-economic status and the size of their PHC, The interventions and control groups were assigned at random. The study uses computerized patient records to individually assess subjects aged 45 to 75 diagnosed with type 1 and type 2 DM, who met the inclusion conditions and who had the variables of particular interest to the study. Trial: The educational interventions consisted of a standardized teaching course aimed at doctors and nurses. The course lasted 6 hours and was split into three 2-hour blocks with subsequent monthly refresher courses. MEASUREMENT: For the health professionals, the study used the Diabetes Attitude Scale (DAS-3) to assess their attitudes and motivation when monitoring diabetes. For the patients, the study assessed factors related to their degree of control over the disease at onset, 6, 12 and 24 months. MAIN VARIABLES: levels of HbA1c. ANALYSIS: The study analyzed the effect of the educational interventions both on the attitudes and motivations of health professionals and on the degree of control over the diabetes in both groups. DISCUSSION: Imparting educational interventions to health professionals would improve the monitoring of diabetic patients. The most effective model involves imparting the course to both doctors and nurses. However, these models have not been tested on our Spanish population within the framework of primary healthcare. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01087541.

Assessment of an enhanced program for depression management in primary care: a cluster randomized controlled trial. The INDI project (Interventions for Depression Improvement).

BACKGROUND: Most depressed patients are attended at primary care. However, there are significant shortcomings in the diagnosis, management and outcomes of these patients. The aim of this study is to determine whether the implementation of a structured programme for managing depression will provide better health outcomes than usual management. DESIGN: A cluster-randomized controlled trial involving two groups, one of which is the control group consisting of patients who are treated for depression in the usual way and the other is the intervention group consisting of patients on a structured programme for treating depression. SETTING: 20 primary care centres in the province of Tarragona (Spain) SAMPLE: 400 patients over 18 years of age who have experienced an episode of major depression (DSM-IV) and who need to initiate antidepressant treatment INTERVENTION: A multi-component programme with clinical, educational and organisational procedures that includes training for the health care provider and evidence-based clinical guidelines. It also includes primary care nurses working as care-managers who provide educational and emotional support for the patients and who are responsible for active and systematic clinical monitoring. The programme aims to improve the primary care/specialized level interface. MEASUREMENTS: The patients will be monitored by telephone interviews. The interviewer will not know which group the patient belongs to (blind trial). These interviews will be given at 0, 3, 6 and 12 months. MAIN VARIABLES: Severity of the depressive symptoms, response rate and remission rate. ANALYSIS: Outcomes will be analyzed on an intent-to-treat basis and the unit of analysis will be the individual patient. This analysis will take into account the effect of study design on potential lack of independence between observations within the same cluster. DISCUSSION: The effectiveness of caring for depression in primary care can be improved by various strategies. The most effective models involve organisational changes and a greater role of nurses. However, these models are almost exclusively from the USA, and this randomized clinical trial will determine if this approach could be effective to improve the outcomes of depression in primary care in the Spanish health care system. TRIAL REGISTRATION: ISRCTN16384353.

Improving the role of nursing in the treatment of depression in primary care in Spain.

PURPOSE: We describe a multicomponent program for the systematic evaluation and treatment of depression in primary care. CONCLUSION: Primary-care nurses trained in clinical and therapeutic aspects of depression play a central role in care management, patient education, treatment adherence, and clinical monitoring. PRACTICE IMPLICATIONS: Diverse interventions, including organizational changes and the enhancement of the role of nurses, have been effective in improving depression outcomes in primary-care settings.

Resultados preliminares del estudio en Banco de Sangre, Cataluña / No disponible

El aumento de población inmigrante procedente de zonas endémicas de Chagas ha creado la necesidad de una actuación en los bancos de sangre de nuestro país. Además, el reciente real decreto sobre hemodonación permite aceptar las donaciones de riesgo siempre que se realice el cribado para marcadores de T. cruzi. El objetivo principal del estudio iniciado en septiembre de 2005 en el Banc de Sang i Teixits es determinar la seroprevalenciade la infección por Trypanosoma cruzi en la población de donantes de riesgo en Cataluña. Se incluyeron en el estudio los donantes de riesgo de Chagas (nacidos, transfundidos o hijos de madre procedente de área endémica) y viajeros/residentes en estancias superiores a un mes. El test de cribado utilizado fue el ID-PaGIA Chagas antibody test (DiaMed). Como test suplementarios se utilizaron el método Bioelisa Chagas (Biokit) y un ELISA in-house con antígenos nativos. Entre Septiembre 2005 y Septiembre 2006,se han analizado 1770 donantes. Por grupos de riesgo, hubo 1524 (86%)donantes nacidos en área endémica, 37 españoles de madre originaria dezona endémica (2%) y 209 (12%) viajeros. Hubo 21 donantes inicialmente positivos en el cribado, de los cuales 11 se confirmaron positivos (0,62%).La mayoría de donantes positivos fueron bolivianos (AU)

The increasing population coming from Chagasic areas has forced blood banksin Spain to take preventive measures. The recent Blood Donation regulation provides with the guidelines to screen blood donations at risk for anti-T. cruziantibodies. The aim of the present study was to determine the prevalence of infection by Trypanosoma cruzi in blood donors at risk in Catalonia. The risk groups included were donors born or transfused in endemic areas and donors whose mother was born in endemic area. Travellers or residents in endemic areas for more than one month were also included. The screening method was ID-PaGIA Chagas antibody test (DiaMed). As supplementary test, Bioelisa Chagas (Biokit) and an in-house ELISA test with native antigens were used. Between September 2005 and September 2006, 1770 donor sat risk were screened. According to risk groups, 1524 (86%) were donorsborn in endemic areas, 37 (2%) were donors whose mother was born in an endemic area and 209 (12%) donors had travelled or lived in endemic areas. Twenty-one donors were initially positive in the screening, of which11 were confirmed positive for the presence of T. cruzi antibodies (0.62%).The majority of T. cruzi positive donors were Bolivians (AU)