National expert consensus on home-administered oncologic therapies in Spain.

The diagnosis and treatment of cancer impose a significant emotional and psychological burden on patients, families, and caregivers. Patients undergo several interventions in a hospital setting, and the increasing number of patients requiring extended care and follow-up is driving the demand for additional clinical resources to address their needs. Hospital at Home (HaH) teams have introduced home-administered oncologic therapies that represent a new model of patient-centered cancer care. This approach can be integrated with traditional models and offers benefits to both patients and healthcare professionals (HCPs). Home-administered treatment programs have been successfully piloted globally, demonstrated as a preferred option for most patients and a safe alternative that could reduce costs and hospital burden. The document aims to establish the minimum recommendations for the home administration of oncologic therapies (ODAH) based on a national expert agreement. The expert panel comprised seven leading members from diverse Spanish societies and three working areas: clinical and healthcare issues, logistical and administrative issues, and economic, social, and legal issues. The recommendations outlined in this article were obtained after a comprehensive literature review and thorough discussions. This document may serve as a basis for the future development of home-administered oncologic therapy programs in Spain. .

NMDA receptors in frontal cortex and hippocampus of alcohol consumers.

Specific binding of [³H]MK801 to N-methyl-D-aspartate (NMDA) receptors in the frontal cortex and hippocampus (CA1 and gyrus dentatus) was measured by receptor autoradiography in 16 Caucasian chronic alcohol consumers free of clinical manifestations of alcoholism, and compared with 16 Caucasian control subjects. Binding densities were not significantly different between heavy and moderate drinkers, neither between alcohol consumers that were abstinent or non-abstinent before death, nor between ethanol drinkers and controls. Continued alcohol consumption, in the absence of hepatic, neurologic or psychiatric disorders related to alcoholism, does not alter the binding properties of NMDA receptors in the brain areas studied.

[Usefulness of a new index for mortality after hospitalization in adults older than 70 years]. / Utilidad de un nuevo índice pronóstico de mortalidad tras el alta hospitalaria en pacientes mayores de 70 años.

BACKGROUND AND OBJECTIVE: Walter et al developed and validated a mortality prognostic index in older adults after hospitalization. Our objective was to evaluate the Walter index utility and to compare it with Charlson index and Barthel index in our population. PATIENTS AND METHOD: 455 patients were included (224 men and 231 women), medium age was 81.4 years (range: 70-99), who were discharged from 4 hospitals in Barcelona. At the moment of discharge Barthel index, Charlson index and Walter index were administered. RESULTS: One year after discharge the mortality was 40.66%. Medium Barthel index (standard deviation) was 64.42 (35.66), medium Charlson index was 3.07 (1.87), and medium Walter index was 5.34 (2.97). ROC curves analysis was done and it shows the bigger area under the curve was Walter index (0.691). CONCLUSIONS: It's proved the Walter index utility for mortality prognostic one year after discharge in elderly people who are admitted in our hospitals. This could be useful to make a care design and therapeutic objectives.

Cost-effectiveness of a Barcelona home care program for individuals with multimorbidity.

To improve the efficiency and effectiveness of care and optimize healthcare resources, a home healthcare program was created for individuals with multiple chronic conditions. Demographic and clinical characteristics of the 261 individuals (mean age 84) included in the program from its inception in 2011 through 2013 (mean stay in the program 203±192 days) were prospectively analyzed. The number of hospital admissions, length of stay, and costs for individuals admitted to the program were compared for two time periods: the 6 months before admission to the program and their stay in the program. After admission to the program, the number of hospital admissions and the hospital length of stay per person per month decreased from 0.36±0.21 to 0.19±0.52 (P<.001) and from 3.5 to 1 day (P<.001), respectively. Surveys of randomly selected patients and caregivers showed high satisfaction with the program. Costs per person per day decreased from €54.65 (US$73.12) to €17.91 (US$23.96), a reduction of 67.1%. Fewer admissions and shorter hospital stays enabled the hospital to eliminate one acute bed for every 50 individuals admitted to the program. In conclusion, home care for individuals with chronic illness with multimorbidity reduced the number of hospital admissions and length of stay, resulting in good patient satisfaction and lower costs.