[Efficacy of a multidisciplinary care management program for patients admitted at hospital because of heart failure (ProMIC)]. / Eficacia de un programa multidisciplinar de gestión de cuidados en pacientes que ingresan por insuficiencia cardiaca (ProMIC).

OBJECTIVE: To assess the efficacy of the ProMIC, multidisciplinary program for patients admitted at hospital because of heart failure (HF) programme, in reducing the HF-related readmission rate. DESING: Quasi-experimental research with control group. SETTINGS: Twelve primary health care centres and 3 hospitals from the Basque Country. PARTICIPANTS: Aged 40 years old or above patients admitted for HF with a New York Heart Association functional class II to IV. INTERVENTIONS: Patients in the intervention group carried out the ProMIC programme, a structured clinical intervention based on clinical guidelines and on the chronic care model. Control group received usual care. MAIN MEASUREMENTS: The rate of readmission for HF and health-related quality of life RESULTS: One hundred fifty five patients were included in ProMIC group and 129 in control group. 45 rehospitalisation due to heart failure happened in ProMIC versus 75 in control group (adjusted hazard ratio=0.59, CI 95%: 0.36-0.98; P=.049). There were significant differences in specific quality of life al 6 months. No significant differences were found in rehospitalisation due to all causes, due to cardiovascular causes, visits to emergency room, mortality, the combined variable of these events, the functional capacity or quality of life at 12 months of follow up. CONCLUSIONS: ProMIC reduces significantly heart failure rehospitalisation and improve quality of life al 6 months of follow up. No significant differences were found in the rests of variables.

Nurse-Supervised Exercise for People with Stage IV Cancer: The EFICANCER Randomized Clinical Trial.

OBJECTIVES: To assess the effectiveness of the EFICANCER individualized and supervised exercise program for people with gastrointestinal, breast, or non-small cell lung stage IV cancer, in terms of quality of life and functional capacity. DATA SOURCES: Randomized controlled clinical trial with two parallel groups: EFICANCER (n = 47) and control (n = 43). Both groups received standard oncological care. In addition, the EFICANCER group participated in a nurse-supervised exercise program. Primary outcome was cancer-specific (EORTC QLQ-C30 questionnaire) and general quality of life (SF-36) at baseline and after 2, 6, and 12 months. Secondary outcomes were functional capacity (6-minute walking test), strength, and fatigue. The evolution in both groups was compared over 12 months using mixed-effect longitudinal models; 74.47% of patients completed at least one session of the program. At 12 months, EFICANCER group had better scores in cancer-related quality of life, with a difference between groups of 15.7 points (95% confidence interval 4.4 to 25.9) and in functional capacity, with a difference of 4.5 points (95% confidence interval -0.5 to 9.5). No significant differences in any other secondary variables were observed. CONCLUSION: The EFICANCER primary care nurse supervised exercise program is safe and feasible and improves cancer patient's outcomes. IMPLICATIONS FOR NURSING PRACTICE: Providing the best care and trying to improve the quality of life of cancer patients are essential parts of nursing practice. Eficancer adds a new dimension to nursing practice by providing greater attention and care to patients during treatment through the supervision of physical exercise, thereby contributing to improve the quality of life of this population.

Iodine contents in conventional ultra-high temperature (UHT) processed cow milk: Changes over the year and regional differences. Implications for epidemiological studies on iodine nutritional status. / Contenido de yodo de la leche convencional ultrapasteurizada (UHT) de vaca: Variaciones a lo largo del año y diferencias regionales. Implicaciones para los estudios epidemiológicos sobre el estado de nutrición de yodo.

BACKGROUND AND OBJECTIVES: Ultra-high temperature (UHT) processed cow milk is the milk most commonly consumed in Southwest Europe. The study objectives were: 1) to describe the pattern followed by iodine concentration (IC) in conventional UHT milk over the year, and 2) to find out any differences in IC in this type of milk depending on its geographical origin. MATERIAL AND METHODS: Bricks of conventional UHT cow milk of commercial brands available in food stores in Vitoria-Gasteiz (Araba/Álava), Basque Country (Spain) were bought for 12 consecutive months, and their ICs were measured using high performance liquid chromatography. RESULTS: Median (P25-P75) IC in UHT milk (n=489) was 190 (159-235)µg/L. IC in milk showed great changes over the year, reaching peak values between January and May (241 [201-272]µg/L), and minimal levels between July and November (162 [134-185]µg/L) (P<.0001). The IC of milk packed in Germany was significantly lower than that of milks packed in Spain and France, 119 (106-156)µg/L versus 189 (159-229)µg/L and 205 (176-243)µg/L respectively (P<.0001). CONCLUSIONS: Conventional UHT cow milk is a very important nutritional source of iodine, but its IC is highly variable. Knowledge of the pattern followed by IC in milk over the year is of great interest for planning epidemiological studies on iodine nutritional status in schoolchildren and for interpretation of their results.

Addressing low-value pharmacological prescribing in primary prevention of CVD through a structured evidence-based and theory-informed process for the design and testing of de-implementation strategies: the DE-imFAR study.

BACKGROUND: De-implementation or abandonment of ineffective or low-value healthcare is becoming a priority research field globally due to the growing empirical evidence of the high prevalence of such care and its impact in terms of patient safety and social inefficiency. Little is known, however, about the factors, barriers, and facilitators involved or about interventions that are effective in promoting and accelerating the de-implementation of low-value healthcare. The De-imFAR study seeks to carry out a structured, evidence-based, and theory-informed process involving the main stakeholders (clinicians, managers, patients, and researchers) for the design, deployment, and assessment of de-implementation strategies for reducing low-value pharmacological prescribing. METHODS: A phase I formative study using a systematic and comprehensive framework based on theory and evidence for the design of implementation strategies-specifically, the Behavior Change Wheel (BCW)-will be conducted to design and model de-implementation strategies to favor reductions in low-value pharmacological prescribing of statins in primary prevention of cardiovascular disease (CVD) by main stakeholders (clinicians, managers, patients, and researchers) in a collegiate way. Subsequently, a phase II comparative hybrid trial will be conducted to assess the feasibility and potential effectiveness of at least one active de-implementation strategy to reduce low-value pharmacological prescribing of statins in primary prevention of CVD compared to the usual procedures for dissemination of clinical practice guidelines ("what-not-to-do" recommendations). A mixed-methods evaluation will be used: quantitative for the results of the implementation at the professional level (e.g., adoption, reach and implementation or execution of the recommended clinical practice); and qualitative to determine the feasibility and perceived impact of the de-implementation strategies from the clinicians' perspective, and patients' experiences related to the clinical care received. DISCUSSION: The DE-imFAR study aims to generate valid scientific knowledge about the design and development of de-implementation strategies using theory- and evidence-based methodologies suggested by implementation science. It will explore the effectiveness of these strategies and their acceptability among clinicians, policymakers, and patients. Its ultimate goal is to maximize the quality and efficiency of our health system by abandoning low-value pharmacological prescribing. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT04022850. Registered 17 July 2019.

[Iodine concentration in ultra-high temperature pasteurized cow's milk. Applications in clinical practice and in community nutrition]. / Concentración de yodo en la leche ultrapasteurizada de vaca. Aplicaciones en la práctica clínica y en la nutrición comunitaria.

BACKGROUND AND OBJECTIVE: Changes to dairy cow feeding have made milk a very important food source of iodine in several European countries and in USA. We aimed to measure the iodine content in ultra-high temperature (UHT) milk, the most widely consumed milk in Spain and in the south-west of Europe. MATERIAL AND METHODS: Every month, throughout 2008, UHT milk samples of commercial brands available in Vitoria-Gasteiz (Basque Country, Spain) were collected and their iodine content was determined using high-performance liquid chromatography, according to official method 992.22 of the Association of Official Analytical Chemists International. RESULTS: The average (SD) iodide content and median (P25-P75) of standard UHT milk samples (n=489) were 197.6 (58.1) and 190 (159-235) µg/L, respectively. There were no significant differences between the iodide content in whole, semi-skimmed and skimmed milk (P=.219). The average iodide concentration and median in organic UHT milk (n=12) were 56.4 (8.6) and 55 (50.5-61.5) µg/L, figures that are much lower than those found in standard milk (P<.0001). CONCLUSIONS: Standard UHT milk available in our food-retailing outlets constitutes a very important source of iodine. One glass of standard UHT milk (200-250mL) provides an average amount of 50µg of iodine. This amount represents around 50% of the iodine intake recommended during childhood or 20% of the iodine intake recommended for pregnant and lactating women.