Effectiveness of Text Messaging as an Adjuvant to Health Advice in Smoking Cessation Programs in Primary Care. A Randomized Clinical Trial.

INTRODUCTION: Smoking remains a major risk factor for chronic diseases. Health advice is considered one of the most cost-effective interventions; however, changes produced by counseling tend not to persist over time, it is necessary to implement enforcement mechanisms. METHODS: Randomized clinical trial to evaluate the effectiveness of a combined program that includes health advice and text messaging to mobile phone (SMSalud®). Patients were randomized to one of two interventions: health advice (control group) or health advice and text messaging (intervention group). We included 320 smoker patients who met the inclusion criteria: being motivated, aged over 18 years, having a mobile phone, being able to read and send messages. Patients were excluded if they had a history of mental or behavioral disorders, or depression. The primary endpoint was the percentage of patients who had stopped smoking by 6 months and confirmed by CO breath test. RESULTS: By 6 months after the start of the program, 24.4% (39/160) of patients in the intervention group and 11.9% (19/160) of controls had stopped smoking (OR: 2.3; 95% CI: 1.3-4.3, p = .007). Patients with no dependence or mild dependence were more likely to stop (28.3%, 36/127 vs. 11.4%, 22/193; OR: 3.0, 95% CI: 1.7-5.5, p < .001). The rate of continuous abstinence at 12 months was 16.3% (26/160) in intervention group patients and 5.6% (9/160) in controls (OR: 3.2; 95% CI: 1.3-5.9).]. CONCLUSIONS: The combined program is effective for smoking cessation. Patients with less tobacco dependence have a higher probability of success. IMPLICATIONS: Health advice is effective for promoting changes in lifestyle but these changes do not persist over time, so we have to use strengthening mechanisms, as e-health, and specifically, mobile phone based interventions. SMSalud® is an innovate program that includes text messaging and health advice, and it's effective for smoking cessation. The only feature that seems to affect the probability of smoking cessation is the degree of tobacco dependence.

Platelet-rich plasma in skin ulcer treatment.

INTRODUCTION: Chronic vascular ulcers are associated with a high use of resources. Conventional treatment consists of wound cleansing, necrotic tissue debridement, prevention, diagnosis, and, if necessary, treatment of infection and dressing application; although conventional treatment has limited effectiveness with wound healing (around 15-30%).8-11 Platelet-rich plasma, used in various fields of medicine, improves chronic vascular ulcer results, but is more expensive. METHODS: A cost-effectiveness analysis was performed using a 48-week period comparing plateletrich plasma with standard care. A meta-analysis of papers identified by a literature search was done. RESULTS: A combined measure of effectiveness at 12 weeks for each treatment option was calculated and served as the basis for estimating the probability of healing at 48 weeks with a Markov model. CONCLUSIONS: The probability of healing and associated costs were 56% and €5224 using platelet-rich plasma and 31% and €5133 with usual care. The incremental cost that must be assumed to achieve additional healing with platelet-rich plasma is €364. .

Tratamiento de la neumonía adquirida en la comunidad en hospitalización a domicilio: resultado clínico en casos con diferente nivel de gravedad / Efficacy of hospital at home (HaH) in the treatment of community-acquired pneumonia (CAP) with different degrees of severity

Fundamento y objetivo: Diferentes sociedades científicas proponen el uso de escalas de severidad más otros criterios adicionales para determinar el lugar de tratamiento de la neumonía adquirida en la comunidad. El objetivo de este estudio es correlacionar el riesgo según 3 reglas de predicción clínica (PSI, CURB-65 y PSCURXO-80) y criterios adicionales con la efectividad de la hospitalización a domicilio (HaD).Pacientes y método: Revisión de los casos de neumonía adquirida en la comunidad remitidos por el servicio de urgencias a HaD entre enero de 2000 y mayo de 2008. Se clasifican según 3 escalas de riesgo y presencia de criterios adicionales y se analiza su asociación con la inefectividad de HaD durante el tratamiento.Resultados: Se admitieron 146 mujeres y 181 hombres (edad media=60,3 años). La media de estancia en HaD fue de 8,6 días. Dos pacientes murieron, 25 (7,7%) fueron reenviados a hospitalización convencional, 219 fueron dados de alta sin incidencias y 81 tras superar complicaciones. La HaD fue efectiva en el 92,3% de los pacientes. El porcentaje fue del 85% para PSI=IV o V sin o con CA, del 80% para CURB-65=2 y del 77,5% para valores entre 10–19 de PSCURXO-80. La eficacia de HaD se relaciona inversamente con la severidad.Conclusiones: La eficacia de HaD en el tratamiento de neumonía adquirida en la comunidad es menor en los pacientes con mayor gravedad definida por medio de diferentes escalas de predicción clínica, pero es eficaz en un elevado porcentaje de casos en los que está indicado el ingreso hospitalario (AU)

Background and objective: Different scientific societies propose the use of scales of severity and additional criteria (AC) in order to determine the setting for the treatment of Community-Acquired Pneumonia (CAP).The objective of this study is to correlate the risk regarding three clinical prediction rules (PSI, CURB-65 and PSCRUXO-80) and AC with the effectiveness of hospital at home (HaH). Patients and method: Evaluation of cases of CAP referred from the Emergency Unit to HaH between January 2000 and May 2008. They were classified regarding three risk scales and presence of AC and its association with the effectiveness of HaH during the treatment was analysed. Results: 146 women and 181 men were admitted, (mean age, 60.3 years). The average stay in HaH was 8.6 days. Two patients died, 25 (7.7%) were admitted to hospital, 219 progressed favourably throughout and 81 after overcoming complications. Hospital at Home was effective in 92.3% of total patients. The rate was 85% for those in PSI=IV or V with or without additional criteria; 80% for CURB-65=2 and 77.5% for a PSCURXO-80 score of 10–19. The effectiveness of HaH is inversely related to severity (AU)ConclusionsHospital a Home (HaD) is an effective and safe care option for many cases of CAP in which hospital admission is normally recommended on the basis of prediction rule scores or additional admission criteria

[Efficacy of hospital at home (HaH) in the treatment of community-acquired pneumonia (CAP) with different degrees of severity]. / Tratamiento de la neumonía adquirida en la comunidad en hospitalización a domicilio: resultado clínico en casos con diferente nivel de gravedad.

BACKGROUND AND OBJECTIVE: Different scientific societies propose the use of scales of severity and additional criteria (AC) in order to determine the setting for the treatment of Community-Acquired Pneumonia (CAP).The objective of this study is to correlate the risk regarding three clinical prediction rules (PSI, CURB-65 and PSCRUXO-80) and AC with the effectiveness of hospital at home (HaH). PATIENTS AND METHOD: Evaluation of cases of CAP referred from the Emergency Unit to HaH between January 2000 and May 2008. They were classified regarding three risk scales and presence of AC and its association with the effectiveness of HaH during the treatment was analysed. RESULTS: 146 women and 181 men were admitted, (mean age, 60.3 years). The average stay in HaH was 8.6 days. Two patients died, 25 (7.7%) were admitted to hospital, 219 progressed favourably throughout and 81 after overcoming complications. Hospital at Home was effective in 92.3% of total patients. The rate was 85% for those in PSI=IV or V with or without additional criteria; 80% for CURB-65=2 and 77.5% for a PSCURXO-80 score of 10-19. The effectiveness of HaH is inversely related to severity. CONCLUSIONS: Hospital a Home (HaD) is an effective and safe care option for many cases of CAP in which hospital admission is normally recommended on the basis of prediction rule scores or additional admission criteria.

Antipiréticos en el tratamiento inicial de la fiebre en niños: mejor ibuprofeno solo que en combinación con paracetamol / Antipyretics in the intial treatment of fever in children: superiorita of ibuprofen alone than in combination with paracetamol

Objetivo: Investigar si la administración de paracetamol más ibuprofeno es superior a cualquiera de ellas sola para aumentar el tiempo sin fiebre y el alivio del malestar en niños febriles atendidos en casa. Métodos: El diseño del estudio es un ensayo clínico aleatorio y enmascarado con tres ramas. Este estudio se realizó con niños de entre 6 meses y 6 años, con temperatura axilar de 37,8-41,0 °C. La intervención consistió en el consejo acerca de medidas físicas para reducir la temperatura, y el consejo y administración de paracetamol más ibuprofeno, paracetamol solo o ibuprofeno solo. Resultados: Con el enfoque de intención de tratar, la administración de paracetamol más ibuprofeno fue superior a la administración de paracetamol con menos tiempo con fiebre en las primeras 4 h (diferencia ajustada, 55 min; intervalo de confianza [IC] del 95%, 33-77; p<0,001). Para menos tiempo con fiebre en 24 h, paracetamol más ibuprofeno fue superior a paracetamol (4,4 h; IC del 95%, 2,4-6,3; p<0,001) y a ibuprofeno solo (2,5 h; IC del 95%, 0,6-4,4; p=0,008). La terapia combinada atajó la fiebre 23 min más rápido que paracetamol solo, pero no más rápido que ibuprofeno solo (−3 min; IC del 95%, 18 a −24; p=0,8). No se halló beneficio para malestar ni otros síntomas, aunque la potencia era pequeña para esos resultados. Los efectos adversos no difirieron entre grupos. Conclusión: Padres, enfermeras, farmacéuticos y médicos que piensan usar medicinas para suplementar las medidas físicas para maximizar el tiempo que los niños pasan sin fiebre deberían empezar usando ibuprofeno, y considerar el beneficio relativo y riesgos de usar paracetamol más ibuprofeno tras 24 h(AU)

Health-related quality of life as a prognostic factor of survival in critically ill patients.

OBJECTIVE: To evaluate whether health-related quality of life prior to admission into an intensive care unit (ICU) is a prognostic factor of hospital and 1 year mortality. DESIGN: Prospective cohort study. SETTING: Fourteen-bed medical-surgical ICU. PATIENTS: A total of 377 patients admitted to the ICU for more than 24 h with 1-year follow-up after discharge from the hospital. INTERVENTION: A health-related quality of life (HRQoL) survey was conducted, using the questionnaire developed by the "Project for the Epidemiological Analysis of Critical Care Patients", to assess patient's quality of life 1 month before ICU hospitalization. RESULTS: Hospital mortality was independently associated with severity assessed by APACHE II, odds ratio (OR) 1.14 [95% confidence interval (CI) 1.08-1.2; P < 0.001], high workload assessed by Nine Equivalents of Nursing Manpower Score > 30 OR 3.6 (95% CI 1.4-9.0; P = 0.006), hospital length of stay prior to ICU admission of more than 2 days OR 2.6 (95% CI 1.3-5.4; P = 0.008), and bad quality of life prior to ICU admission assessed by a HRQoL score > or = 8 points OR 2.2 (95% CI 1.03-4.5; P = 0.04). Patients who scored > or =8 on the HRQoL survey presented a risk of demise 12 months after discharge almost twofold that of those who had good previous HRQoL (0-2 points), Hazard Ratio 1.9 (95% CI 1.3-2.8; P = 0.001). CONCLUSION: Bad quality of life is associated with hospital mortality and survival 12 months after hospital discharge.

Situación inmune en el anciano con neumonía durante el episodio agudo y tras el alta / Immune status in the elderly with pneumonia during the acute episode and after discharge

Objetivo: analizar la situación inmunológica básica de la neumonía en el anciano (NEA) durante el ingreso y a los 6 meses tras el alta, y su relación con la mortalidad. Material y métodos: estudio prospectivo en pacientes mayores de 65 años con NEA que ingresaron en el Servicio de Medicina Interna en el Hospital Virgen del Camino (Pamplona) en 2 años. Se estudian los datos epidemiológicos, clínicos, etiológicos, analíticos y antropométricos en el ingreso, y la evolución de la NEA al año del alta. Se determinan linfocitos totales, linfocitos T CD4, CD8, CD4/CD8, inmunoglobulinas, complemento (C3, C4, CH50), anticuerpos antinucleares (ANA), factor reumatoide e interleucina 6 (IL-6) en sangre periférica, así como multitest durante el ingreso. A los 6 meses del alta se estudian: linfocitos totales, linfocitos T, CD4, CD8, CD4/CD8 e IL-6. Para realizar las comparaciones entre los diversos parámetros, se aplica un nivel de significación de p < 0,05. Resultados: en el período estudiado se admitió a 125 pacientes con una edad media de 77,9 años (65-95). Fallecieron 11 pacientes (8,8%) durante el ingreso. En el seguimiento ambulatorio durante un año falleció un 30%. Los pacientes que fallecieron tuvieron menos linfocitos totales (p = 0,01), linfocitos T (p = 0,005), CD4 (p = 0,002), C3 (p = 0,001) y C4 (p = 0,001) que los que sobrevivieron. Los ANA estaban presentes en mayor proporción entre los fallecidos (p = 0,017). No se encontraron relaciones evidentes entre los parámetros inmunológicos estudiados y la mortalidad ambulatoria. Los linfocitos totales, linfocitos T, CD4 y los CD8 se recuperan significativamente a los 6 meses tras el alta. En cambio, los valores de IL-6 disminuyen a los 6 meses respecto al ingreso (p = 0,009). Conclusiones: las variables relacionadas con mayor mortalidad durante la NEA fueron: linfocitos totales, linfocitos T, CD4, CD8, C3, C4 y ANA. Se describe un aumento significativo de los valores de inmunidad celular a los 6 meses del alta

Objective: to analyze immune status in elderly patients with pneumonia during admission and at 6 months after discharge, as well as its association with mortality. Material and methods: we performed a prospective study in patients aged > 65 years old with pneumonia admitted to the Internal Medicine Department of the Hospital Virgen del Camino (Pamplona) over a 2-year period. Epidemiological, etiological, laboratory and anthropometric data were studied at admission and 1 year after discharge. Total lymphocytes, T lymphocytes, CD4, CD8, CD4/CD8, immunoglobulins, complement (C3, C4, CH50), antinuclear antibodies (ANA), rheumatoid factor and interleukin-6 (IL-6) in peripheral blood, as well as the multitest during admission, were studied. The following variables were studied 6 months after discharge: total lymphocytes, T lymphocytes, CD4, CD8, CD4/CD8, and IL-6. For the comparison of variables, a significance level of p < 0.05 was set. Results: during the study period, 125 patients with a mean age of 77.9 years (65-95) were admitted. Eleven patients (8.8%) died during admission. During the 1-year outpatient follow-up, 30% died. Patients who died had lower total lymphocyte (p = 0.01), T lymphocyte (p = 0.005), CD4 (p = 0.002), C3 (p = 0.001) and C4 (p = 0.001) levels than those who survived. Higher ANA concentrations were found among patients who died (p = 0.017). No clear associations were found between the immunological parameters studied and outpatient mortality. Levels of total lymphocytes, T lymphocytes, CD4 and CD8 were significantly increased at 6 months after discharge. In contrast, IL-6 levels were lower at 6 months after discharge than on admission (p = 0.009). Conclusions: the variables related to higher mortality in pneumonia in the elderly were total lymphocytes, T-lymphocytes, CD4, CD8, C3, C4 and ANA. Values of cellular immunity were significantly increased 6 months after discharge

[Pneumonia in the elderly. Factors related with the mortality during the episode and after the discharge]. / Neumonía en el anciano. Factores relacionados con la mortalidad durante el episodio y tras el alta hospitalaria.

BACKGROUND AND OBJECTIVE: Pneumonia in the elderly (PIE) is a growing disease that causes great morbidity and mortality with frequent admissions to hospital and increasing health costs. The objective of our study was yo analyze the characteristics of PIE in an internal medicine hospital ward, the influence of quality of life (Katz index and scale of Karnofsky) on its evolution and after the discharge and the factors of poor prognosis during the episode of PIE and throughout the ambulatory follow-up. PATIENTS AND METHOD: All the patients suffering from PIE admitted to the internal medicine ward of our hospital during a two years period were included in the study (125). Five of them were referred from geriatric centers. Mean age was 77.9 years (range = 65-95). The most frequent chronic disease was COPD (53.6%) and 10.4% were taking oral corticosteroids. We studied the association of several factors laboratory, clinical and radiological with the evolution of PIE and after discharge. RESULTS: Patients rated high on the indicators of quality of life used (78.4% scored 5 or greater on the Katz index and 76% scored 80 or greater on the scale of Karnofsky) and their comorbidity was low (44% lesser than or equal to 1 and 6.4% greater than or equal to 5). Fever above 38 C was recorded in 40% of cases. Mean APACHE score was 12.8. 21.6% patients had pleural effusion and 20% had multilobar involvement. Overall mortality was 8.8% (11 patients). Fifteen patients suffered major complications during admission. One hundred patients out of the 114 who survived the episode of PIE were followed up on an ambulatory basis. Thirty of those died within 12 months after discharge. CONCLUSIONS: In our study, a poorer quality of life and a higher APACHE score were related to a greater mortality during the episode of PIE. After hospital discharge, a greater mortality was associated with a poor quality of life, comorbidity and low concentrations of albumin.