Postoperative treatment compliance rate and complications with two different protocols after pterygium excision and conjunctival autografting.

AIM: To evaluate compliance rate to pterygium postoperative treatment with two different protocols. METHODS: Review of clinical data of patients submitted to pterygium excision and conjunctival autografting in a single centre (and a single surgeon) in Barcelona between March 2014 and December 2017. Initial postoperative protocol (protocol 1) consisted of 4 months of topical steroids in a tapering fashion. Protocol 2 consisted of topical steroids tapered over 5 weeks. Compliance rate, complications and clinical outcomes were evaluated, and statistical comparisons were made. RESULTS: 120 surgeries were performed in 99 patients. Protocol 1 was applied in 63 cases and the next 57 followed protocol 2. Compliance with protocol 1 (57.6%) was lower than with protocol 2 (84.9%) (p = 0.002). Intraoperative complications (graft tear, corneal thinning, corneal perforation and bleeding) were found in 10 cases of protocol 1 and three cases of protocol 2, p = 0.08. Postoperative complications (graft dislocation, graft haematoma, ocular hypertension and recurrence) were found in 31 cases of protocol 1 (46.2%) and eight cases of protocol 2 (14%), p = 0.001. Six weeks after surgery, ocular hypertension was detected in eight cases corresponding to protocol 1 (13.6%) and two cases of protocol 2 (3.8%), p = 0.099. Recurrence rate during first year was higher in protocol 1 (26.3%) compared to protocol 2 (7.6%), p = 0.011. No cases of visual acuity worsening or infection were registered. CONCLUSION: Protocol 2 has shown to have higher compliance rate than protocol 1 and less postoperative complications, proving to be a safe and effective postoperative treatment after pterygium surgery.

Patient participation in the discussions of options in Spanish primary care consultations.

OBJECTIVES: To determine patients' participation in the discussion of options in primary care consultations. Identify the patients' wish to participate and their perceptions of their participation and explore the potential factors that may influence these. DESIGN: Cross-sectional study. Setting. Ninety-seven general practices. Participants. six hundred and fifty-eight patients who went to their doctors for unselected reasons. Measurements. All the encounters were videoed, patient participation in decision making (DM) was assessed with two tools. After the consultation, GPs completed a questionnaire about biomedical and relational information. Patients' preferences and perception of participation was explored with different type of questions. RESULTS: Encounters successfully videoed: 638. Of these, only 90 interviews clearly showed patient participation. In 161 other interviews, patient participation was considered possible. Questionnaires collected: 645. In 60% of the situations (390 encounters), patients wished they could have stated their views about the proposed option(s), but they perceived this did not happen. The degree of participation at the consultation did not relate significantly with the physician's ideas about the type of problem, evolution and treatment. Neither did any of the considered variables influence either the patients' wish to participate in the discussion of the suggested option or their perception of this. CONCLUSIONS: GPs ask patients for their opinion and promote discussion about the suggested plan in few encounters. Patients perceive this, including many patients that previously had declared not to be interested in being involved in decisions. These results revealed an important mismatch between what patients wish and what they perceive.

[Quantifying plasma levels of transforming growth factor beta1 in idiopathic pulmonary fibrosis]. / Determinación en plasma del factor transformador del crecimiento beta1 en la fibrosis pulmonar idiopática.

OBJECTIVE: Transforming growth factor ss1 (TGF-ss1) is one of the key profibrotic mediators in the pathogenesis of idiopathic pulmonary fibrosis (IPF). The purpose of this study was to investigate the prognostic value of quantifying TGF-ss1 levels in patients with IPF. PATIENTS AND METHODS: We conducted a prospective study of 29 IPF patients and 27 healthy controls. Enzyme-linked immunosorbent assays were used to quantify TGF-ss1 levels. RESULTS: Mean (SD) TGF-ss1 levels were significantly higher in the IPF patients than in the control subjects (11.1 [7.5] ng/mL vs 4 [2.4] ng/mL; P< .01). Weak inverse correlations were observed between TGF-ss1 levels and both forced vital capacity and total lung capacity. Thirteen IPF patients were evaluated at 8 (1.2) months (range, 5-9 months). The mean TGF-ss1 level was 18.2 (15) ng/mL and there were no significant differences with respect to the initial measurement of 11.1 (7.5) ng/mL. No correlation was observed between changes in respiratory function and changes in TGF-ss1 levels. CONCLUSIONS: Although plasma levels of TGF-beta1 were high in the patients with IPF, they do not appear to be a useful prognostic marker of disease activity or therapeutic response.