Cost-Effectiveness of the Comprehensive Interdisciplinary Program-Care in Informal Caregivers of People with Alzheimer's Disease.

People with Alzheimer's disease (AD) diagnosis who get informal care remain at home longer, reducing the demand for healthcare resources but increasing the stress of caregiving. Research on the effectiveness of physical training, psychoeducational, cognitive-behavioural, and health education programs in reducing the caregiver load and enhancing health-related quality of life (HRQoL) exist, but none exist about an integrated interdisciplinary program. The goals of this project are (1) to assess the Integral-CARE Interdisciplinary Program (IP) applicability, safety, effects on HRQoL, and the incremental cost-effectiveness ratio for AD caregivers; (2) to evaluate the IP applicability and cost-effectiveness to enhance the physical, psychoemotional, cognitive-behavioural dimensions, and the health education status of informal caregivers, and (3) to study the transference of the results to the public and private sectors. A randomized controlled trial will be conducted with an experimental (IP) and a control group (no intervention). The PI will be conducted over nine months using face-to-face sessions (twice a week) and virtual sessions on an online platform (once a week). There will be an initial, interim (every three months), and final assessment. Focus groups with social and health agents will be organized to determine the most important information to convey to the public and private sectors in Extremadura (Spain). Applicability, safety, HRQoL, incremental cost-effectiveness ratio, and HRQoL will be the main outcome measures, while secondary measures will include sociodemographic data; physical, psychoemotional, health education, and cognitive-behavioural domains; program adherence; and patient health status. Data will be examined per procedure and intention to treat. A cost-effectiveness study will also be performed from the viewpoints of private and public healthcare resources.

Clinical and Economic Impact of Wound Care Using a Polyurethane Foam Multilayer Dressing.

OBJECTIVE: To study the impact of a newly introduced dressing on efficiency and quality of care in routine clinical practice in a Spanish community setting. DESIGN AND SETTING: An ambispective multicenter observational study was conducted in 24 primary care centers and 6 nursing homes in 4 different Spanish regions. The study was carried out between November 2017 and March 2019. PATIENTS AND INTERVENTION: A total of 128 wounds in 94 patients (primary care, n = 79; nursing home, n = 15) were analyzed before and 4 weeks after switching to the study dressing. OUTCOME MEASURES: Frequency of dressing changes; secondary outcomes were change in the mean wound area and weekly cost and patient and provider satisfaction. MAIN RESULTS: The mean number of dressing changes was significantly reduced with the study dressing from 3.14 ± 1.77 changes per week to 1.66 ± 0.87 (P < .001), a 47.1% reduction in frequency. Wound area significantly reduced from 9.90 ± 19.62 cm to 7.10 ± 24.33 cm. In addition, a 58.7% reduction in weekly costs was achieved with the intervention. Patients and providers agreed that their satisfaction with wound care improved. CONCLUSIONS: The use of the study dressing in routine clinical practice could lead to a major improvement in both efficiency and quality of wound care. Its use could reduce wound care-related costs through improvements in healing and a reduced frequency of dressing changes. It also enhanced the wound care experience from the perspective of both patients and providers.

Eficiencia de un apósito innovador en la cura de heridas: reducción de la frecuencia de cambio y del coste semanal por paciente / The efficiency of an innovative dressing in wound healing: reduction of change frequency and weekly cost per patient

OBJETIVOS: Evaluar el impacto en la frecuencia de cambio de apósito y en el coste del tratamiento de las heridas que tiene la utilización de un apósito de espuma hidrocelular con indicador de cambio y capa enmascaradora de exudado, y valorar la satisfacción del paciente y la opinión del profesional de enfermería con el apósito de estudio frente a los tratamientos previos. METODOLOGÍA: Estudio observacional, ambispectivo, multicéntrico, realizado en atención primaria y sociosanitaria, en cuatro regiones de España. Participaron pacientes con heridas exudativas, en las que se fuera a sustituir apósitos previos por el apósito del estudio (ALLEVYN Life) según práctica clínica habitual. En cada región, se recogieron y analizaron características de las heridas (antigüedad, localización, tratamientos anteriores, área de la herida), frecuencia de cambio de apósito, coste semanal por paciente (apósitos utilizados y tiempo de enfermería dedicado a curas), satisfacción del paciente y opinión del profesional de enfermería. RESULTADOS: Se incluyó un total de 128 heridas (Galicia: 29; País Vasco: 30; Extremadura: 25, y Comunidad Valenciana: 44). Tras 4 semanas de uso del apósito del estudio se redujo significativamente la frecuencia de cambio (29-58%) y el coste semanal por paciente (apósitos utilizados: 11-61%; apósitos + tiempo de enfermería: 27-59%). En la mayoría de regiones, la reducción del área fue superior al 30%. La experiencia global de los pacientes mejoró con el apósito de estudio frente al tratamiento previo, y fue buena o muy buena en el 60-78% de los casos. En todas las regiones, el profesional de enfermería consideró los apósitos ALLEVYN Life superiores en rendimiento global, indicación de idoneidad de cambio y enmascaramiento del exudado. CONCLUSIONES: El uso del apósito con indicador de cambio y capa enmascaradora disminuyó la frecuencia de cambio de apósito, lo que permitió prolongar los intervalos entre visitas y reducir costes asociados. Al mismo tiempo, mejoró la opinión del profesional de enfermería, y aumentó la satisfacción del paciente

OBJECTIVES: To assess the impact on the dressing change frequency and cost of wound management of using a hydrocellular foam dressing with change indicator and exudate masking layer, and to evaluate the patient's satisfaction and nurse's opinion of the study dressing versus previous treatments. METHODS: Observational, ambispective, multicenter study conducted in primary care and social health care, in four regions of Spain. Patients with acute or chronic exuding wounds, in which previous dressings were to be replaced by the study dressing (ALLEVYN Life) according to usual clinical practice, participated. In each region, wound characteristics (evolution period, location, previous dressings, wound area), dressing change frequency, weekly cost per patient (dressings used and nursing time spent), patient satisfaction and nursing staff opinion were collected and analysed. RESULTS: A total of 128 wounds were included (Galicia: 29; Basque Country: 30; Extremadura: 25; and Valencia: 44). After four weeks of use of the study dressing the frequency of change (29-58%) and the weekly cost per patient were significantly reduced (dressings used: 11-61%; dressings + nursing time: 27-59%). In most regions, the area reduction was more than 30%. The overall patient satisfaction with the study dressing was improved, being good or very good in 60-78% of cases. In all regions, nurses considered ALLEVYN Life dressings superior in overall performance, indication of change adequacy and exudate masking. CONCLUSIONS: The use of the dressing with change indicator and masking layer decreased the frequency of dressing changes, allowing for longer intervals between visits and reducing associated costs. At the same time, they improve the opinion of the nursing staff, and increased patient satisfaction

Naturalis historia de Plinio: concepción y terapéutica. A propósito de los cuidados de la mujer / Naturalis historia Plínio; desenho e terapêutica. Sobre o atendimento de mulheres / Plinie’s natural history: design and therapeutics. About the care of women

Las fuentes bibliográficas son elementos básicos para el estudio de los cuidados. El objetivo de trabajo es la reconstrucción histórica de los cuidados de la mujer, en la época romana, a principios del siglo I d C. centrándolo en la función de concepción y parto y en la terapéutica empleada. Mediante metodología cualitativa, Método histórico, centrado en la hermenéutica, se estudia y analizan las características de la concepción, así como la terapéutica empleada para paliar los problemas de la mujer en el ciclo vital de la reproducción en la época romana, desde un paradigma constructivista. La fuente utilizada es la Historia Natural de Cayo Plinio Segundo, estructurado en 37 libros. A medicina se dedican el libro XXVI. Abundan los dedicados a terapéutica y farmacopea a partir de animales y plantas, estableciendo el remedio a utilizar para facilitar la concepción, así como cada uno de los problemas en la menstruación, embarazo y parto en la mujer de la época romana. Recopilación la farmacopea romana de principios del siglo I a C. Utiliza plantas y animales como elementos naturales de formula terapéutica que alivian, sanan o curan diferentes problemas de salud de la mujer en particular: concepción, embarazo, parto, puerperio y menstruación (AU)

The bibliographical sources are basic elements of care study. The aim of work is the historical reconstruction of caring for women in the Roman era in the early C. I d focusing on the role of design and delivery and the treatment employed. Using qualitative methodology, historical method, focusing on hermeneutics, we study and analyze the characteristics of the design and the therapy used to alleviate the problems of women in the life cycle of reproduction in Roman times, from a constructivist paradigm The source used is the Key Pliny’s Natural History Second, structured in 37 books. A book dedicated medical XXVI. There are plenty of dedicated therapeutic pharmacopoeia here are plenty of dedicated therapeutic pharmacopoeia from animals and plants, providing the remedy to be used to facilitate the design, and each of the problems with menstruation, pregnancy and childbirth in women from Roman times Collecting Roman pharmacopoeia of the early century to C. Use plants and animals and natural elements of therapeutic formula that soothe, heal or cure various health problems of women in particular: conception, pregnancy, childbirth, childbirth and menstruation (AU)

As fontes bibliográficas são elementos básicos de estudo cuidado. O objetivo do trabalho é a reconstrução histórica de cuidar de mulheres na era romana no início dos anos C. I d enfocando o papel do design e de entrega e do tratamento empregado. Utilizando metodologia qualitativa, método histórico, com foco na hermenêutica, que estudar e analisar as características do design e da terapia utilizada para aliviar os problemas das mulheres no ciclo de vida de reprodução no tempo dos romanos, a partir de um paradigma construtivista A fonte utilizada é a chave de Plínio Segundo História Natural, estruturado em 37 livros. Um livro dedicado médica XXVI. Há uma abundância de farmacopéia terapêutica dedicada de animais e plantas, fornecendo o remédio a ser usado para facilitar o design, e cada um dos problemas com a menstruação, gravidez e parto em mulheres da época romana Coleta de Roman farmacopéia do início do século a C. Use plantas e animais e elementos naturais da fórmula terapêutica que aliviar, curar ou curar vários problemas de saúde das mulheres em particular: concepção, gravidez, parto, parto e menstruação (AU)