IBD-PODCAST Spain: A Close Look at Current Daily Clinical Practice in IBD Management.

BACKGROUND: Crohn's disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBD) that contributes in part to irreversible bowel damage and long-term complications, reduced quality of life, invalidity, and economic burden. Suboptimal control of IBD is associated with higher healthcare resource utilization (HCRU), impaired quality of life (QoL), and reduced work productivity. AIMS: The IBD-PODCAST study aimed to assess the proportion of IBD patients with suboptimal control and its associated impact. METHODS: IBD-PODCAST is a cross-sectional, multicenter study that aimed to characterize the CD and UC population with optimal or suboptimal control according to the STRIDE-II criteria and patient- and physician-reported measures. Here we present the results of the Spanish cohort (n = 396). RESULTS: A total of 104/196 (53.1%) CD and 83/200 (41.5%) UC patients were found to have suboptimal disease control. Long-term treatment targets according to STRIDE-II were applied in 172 (87.8%) CD and 181 (90.5%) UC patients. 125 of 172 (72.7%) CD and 74 of 181 (40.9%) UC patients were currently treated with targeted immunomodulators. Patients with CD and UC and suboptimal disease control showed impaired QoL, higher HCRU and direct costs, and also loss of work productivity compared to those with optimal control. CONCLUSION: Despite a high rate of targeted immunomodulator therapy, a substantial proportion of IBD patients show suboptimal disease control according to the STRIDE II criteria. Those patients with suboptimal disease control exhibit impaired QoL, less work productivity, and higher HCRU, suggesting that there is considerable need for better treatment approaches in IBD.

Estudio piloto prospectivo del deterioro cognitivo en pacientes oncológicos paliativos ambulatorios / Prospective pilot study of cognitive impairment in palliative oncologic outpatiens

Diversos estudios sugieren que los trastornos cognitivos pueden ser frecuentes en pacientes con cáncer avanzado. Su prevalencia es muy variable (8-90%) y son pocos los estudios prospectivos con pacientes paliativos ambulatorios. Objetivo: estudiar la prevalencia del deterioro cognoscitivo en pacientes paliativos oncológicos ambulatorios y precisar la prueba de cribado cognitivo más sensible. Método: Muestra: dieciséis pacientes oncológicos paliativos, 7 hombres y 9mujeres, con una media de edad de 73 años (±12,9) y 3,8 años de escolarización (±3,3). El diagnóstico mayoritario fue de neoplasia digestiva. Durante la valoración cognitiva tres pacientes estaban tratados con mórficos. Material: se administró ambulatoriamente una batería cognitiva que incluía el mini-examen cognitivo de Lobo (MEC), la escala de evaluación cognitiva de Clifton (CAS), la evaluación rápida de funciones cognitivas de Gil (ERFC) y el subtest de claves del WAIS-III. Resultados: se excluyeron cuatro pacientes al presentar, tras evaluación neuropsicológica, un deterioro cognitivo cortical difuso sugestivo de posible demencia degenerativa primaria. De los 12 pacientes restantes evaluados, el CAS y el ERFC objetivaron un deterioro cognitivo leve en 4 y 9 casos respectivamente. Mediante el MEC se detectó un solo caso. Conclusiones: la mayoría de los pacientes oncológicos paliativos tienen un déficit cognoscitivo leve y, posiblemente, específico. El MEC parece tener menor sensibilidad para detectar dicho trastorno, respecto al CASy el ERFC. El enlentecimiento motor y mental parecen ser el deterioro cognoscitivo más característico de dicha población. Finalmente, el déficit cognitivo no parece ser una variable relevante para predecir la esperanza de vida (AU)

Several studies suggest that cognitive impairment can often appear in advanced cancer patients. Its prevalence is very variable (8-90%) and there is very little prospective research with palliative outpatients. Objective: studying the prevalence of the cognitive impairment in palliative oncologic outpatients and specifying the most sensitive cognitive screening test. Method: Subjects: sixteen onchological palliative patients, 7 men and 9 women, with an average age of 73 years old (±12,9) and 3,8 school years (±3,3). The main diagnosis was the digestive neoplasia. During the cognitive examination, three of the patients were being treated with morphic. Material: a battery of cognitive tests was administered in an ambulatory way. This battery included the mini-exam cognitive of Lobo (MEC), the cognitive evaluation scale of Clifton (CAS), the quick assessment of cognitive function of Gil (ERFC) and the subtest of digit symbol from WAIS-III. Results: four patients was excluded, after neuropsychological assessment, because they showed a diffuse cortical cognitive failure, which suggested the possibility of the existence of dementia. CAS and ERFC showed, in the rest of the 12 patients, a light cognitive impairment in 4 and 9 of the subjects, respectively. By the use of MEC, only one case was detected. Conclusion: the majority of the palliative onchological outpatient shave specific light cognitive deterioration. MEC seems to have less perceptibility than CAS and ERFC to detect that impairment. The slowness of mind activity and movements seem to be the most common cognitive failure in this group of outpatients. Finally, cognitive failure is not related to mortality risk (AU))