The costs of stroke in Spain by aetiology: the CONOCES study protocol.

INTRODUCTION: Patients with stroke associated with non-valvular atrial fibrillation (NVAF) are a specific group, and their disease has a considerable social and economic impact. The primary objective of the CONOCES study, the protocol of which is presented here, is to compare the costs of stroke in NVAF patients to those of patients without NVAF in Spanish stroke units from a societal perspective. MATERIALS AND METHODS: CONOCES is an epidemiological, observational, naturalistic, prospective, multicentre study of the cost of the illness in a sample of patients who have suffered a stroke and were admitted to a Spanish stroke unit. During a 12-month follow-up period, we record sociodemographic and clinical variables, score on the NIH stroke scale, level of disability, degree of functional dependency according to the modified Rankin scale, and use of healthcare resources (hospitalisation at the time of the first episode, readmissions, outpatient rehabilitation, orthotic and/or prosthetic material, medication for secondary prevention, medical check-ups, nursing care and formal social care services). Estimated monthly income, lost work productivity and health-related quality of life measured with the generic EQ-5D questionnaire are also recorded. We also administer a direct interview to the caregiver to determine loss of productivity, informal care, and caregiver burden. RESULTS AND CONCLUSIONS: The CONOCES study will provide more in-depth information about the economic and clinical impact of stroke according to whether or not it is associated with NVAF.

[Quality as management tool. Actions to improve efficiency in neurological care]. / La calidad como herramienta de gestión. Actuaciones para mejorar la eficiencia en la atención neurológica.

INTRODUCTION: Quality of care involves meeting the needs and expectations of patients with the lowest consumption of resources and in accordance with scientific knowledge. In this context it is important to know if the changes in medical care procedures based on scientific and technical aspects of the quality positively impacts both efficiency measures and perceived quality. METHODS: Prospective study carried out during the 2000-2006 period at the neurology department of a public hospital with has 1303 beds. Changes in medical care introduced: adequacy of a high resolution hospitalization zone, setting up of three care pathways (transient ischemic attach [TIA], multiple sclerosis exacerbation and first epileptic seizure) and practice guidelines for stroke, and implementation of neurological care at the emergency department. RESULTS: There has been an increase in the number of patients treated in the emergency department of the hospital (17%), although the number of admissions has stabilized. In the neurology department, the number of admissions has decreased by 20%, especially those arising from TIA (decrease by 47%), the average stay has been reduced by 30% (especially in demyelinating and vascular disease, which has fallen by 50%). Adjusted average length of stay has remained below 1 and the complexity index above 1. Satisfaction with the information and health care has undergone little change. CONCLUSIONS: The changes in clinical practice to improve the quality of care have been associated with improvements in the efficiency indicators but not in patient satisfaction. The improvement in the perceived quality probably requires specific actions.

La calidad como herramienta de gestión. Actuaciones para mejorar la eficienciaen la atención neurológica / Quality as management tool. Actions to improve efficiency in neurological care

Introducción. La calidad asistencial supone satisfacer las necesidadesy expectativas de los pacientes con el menor consumo de recursosy de acuerdo al conocimiento científico. En este contexto esimportante conocer si los cambios en los procesos asistenciales basadosen aspectos científico-técnicos de la calidad repercuten positivamentetanto en medidas de eficiencia como de calidad percibida.Métodos. Estudio prospectivo durante el período 2000-2006realizado en el servicio de neurología de un hospital de tercer nivelde la red del Sistema Nacional de Salud que dispone de 1.303 camas.Cambios asistenciales introducidos: adecuación de una zona de hospitalizaciónde alta resolución, implantación de tres vías clínicas(accidente isquémico transitorio [AIT], exacerbación de esclerosismúltiple y primera crisis epiléptica) y del proceso de atención al pacientecon ictus y mejora de la atención neurológica en el servicio deurgencias.Resultados. En el hospital se ha producido un incremento en elnúmero de urgencias atendidas (17%), estabilizándose el número deingresos. En neurología ha disminuido el número de ingresos en un20%, especialmente los debidos a AIT (disminución del 47 %), la estanciamedia se ha reducido en un 30% (especialmente en patologíavascular y desmielinizante, donde ha disminuido un 50 %), elíndice de estancia media ajustada al funcionamiento se ha mantenidopor debajo de 1 y el índice de complejidad por encima de 1. La satisfaccióncon la información y atención médica han experimentadopocos cambios.Conclusiones. Los cambios de práctica clínica para mejorar lacalidad asistencial se han asociado con mejoras en los indicadores deeficiencia, pero no en los de satisfacción del paciente. La mejora decalidad percibida probablemente requiera actuaciones específicas (AU)

Introduction. Quality of care involves meeting the needsand expectations of patients with the lowest consumption of resourcesand in accordance with scientific knowledge. In this contextit is important to know if the changes in medical care proceduresbased on scientific and technical aspects of the qualitypositively impacts both efficiency measures and perceived quality.Methods. Prospective study carried out during the 2000-2006period at the neurology department of a public hospital with has1303 beds. Changes in medical care introduced: adequacy of ahigh resolution hospitalization zone, setting up of three carepathways (transient ischemic attach [TIA], multiple sclerosis exacerbationand first epileptic seizure) and practice guidelines forstroke, and implementation of neurological care at the emergencydepartment.Results. There has been an increase in the number of patientstreated in the emergency department of the hospital (17%),although the number of admissions has stabilized. In the neurologydepartment, the number of admissions has decreased by20%, especially those arising from TIA (decrease by 47 %), theaverage stay has been reduced by 30% (especially in demyelinatingand vascular disease, which has fallen by 50%). Adjustedaverage length of stay has remained below 1 and the complexityindex above 1. Satisfaction with the information and health carehas undergone little change.Conclusions. The changes in clinical practice to improvethe quality of care have been associated with improvements in theefficiency indicators but not in patient satisfaction. The improvementin the perceived quality probably requires specific actions (AU)

[Application of a clinical pathway for the treatment of transient ischaemic attacks: implementation strategies and appraisal at two years]. / Aplicación de una vía clínica para el tratamiento del accidente isquémico transitorio: estrategias de implantación y evaluación a los dos años.

INTRODUCTION: Management of cerebral vascular pathologies by means of clinical pathways allows us to make cost effective use of resources, to enhance health care quality and to obtain a greater degree of satisfaction in patients. AIMS: To assess the efficiency of applying a clinical pathway designed for the treatment of transient ischemic attacks (TIA) by monitoring a series of indicators that enable us to detect existing problems, to introduce any corrections that are needed and to draw conclusions that can be useful in the future. PATIENTS AND METHODS: To this end, a clinical pathway was drawn up with the general agreement of the members of our service and the different professionals involved in caring for these patients. Analyses were performed to study the data from 1998 to 2001, prior to implementation of the pathway, and from 2002 and 2003, which were the first years in which it was being applied. Altogether 1,433 patients with a diagnosis of TIA were hospitalised during this period, 554 of whom were admitted during the years 2002 and 2003. RESULTS: Of this group, the pathway was initially applied in 123 cases and 62 completed it. The mean stay in hospital was reduced from 9.2 days in 2000 to 5.7 days in 2003. The mean stay of patients who fulfilled all the requirements of the pathway was only 2.9 days. As far as the survey on satisfaction is concerned, 97% of patients said they were satisfied or very satisfied with the care they had received. CONCLUSIONS: The application of a clinical pathway in the treatment of TIA resulted in a high degree of satisfaction among the patients who were treated and a notable reduction in the mean stay in hospital.

Estudio epidemiológico de gliomas mixtos en Aragón y La Rioja / Epidemiological study of mixed gliomas in Aragon and La Rioja

No disponible

Estudio epidemiológico de adenomas hipofisarios en Aragón y La Rioja / An epidemiological study of hy`pphyseal adenomas in Aragon and La Rioja

No disponible

[Spontaneous intracranial hypotension: findings of cerebral NMR]. / Hipotensión intracraneal espontánea: hallazgos en RMN cerebral.

INTRODUCTION: The intracranial hypotension syndrome is characterized by a cerebrospinal fluid (CSF) pressure of less than 60 mmH2O and presents as postural hypotension which is often accompanied by nausea, vomiting, cervicalgia and some degree of neck rigidity. It is considered to be spontaneous when there is no known precipitating factor. It is believed that there is a CSF leak across the subarachnoid space, although it is not always possible to detect this. In recent years several authors have described different pathological findings on magnetic resonance (MR) studies. CLINICAL CASE: We present the radiological studies of a patient with clinical evidence of headache which was worse on standing and improved when lying down. The outflow pressure of CSF was 6 mmH2O when lying down. On isotopic cisternography using Tc DTPA-99m there was no detectable CSF leak. On cerebral MR there was diffuse pachymeningeal thickening with increased signals in T1 sequences. This was more pronounced in T2 with lineal dural uptake of contrast at infra and supratentorial levels. The brain stem meninges were intact. In parallel with a favorable clinical course, following clinical resolution the radiological images were seen to have returned to normal. CONCLUSIONS: Radiological findings, together with a compatible clinical condition, help to establish the diagnosis of spontaneous intracranial hypotension and avoids the use of unnecessary clinical investigations.