OBJECTIVES: This study aimed to explore the clinical characteristics of amyotrophic lateral sclerosis (ALS) patients in Spain's north-eastern region, their inclusion in chronic care programmes, and their psychosocial and spiritual needs (PSNs). METHODS: A longitudinal descriptive study in adult patients with ALS. We analyzed clinical variables and participation in chronicity and PSNs assessment using the tool Psychosocial and Spiritual Needs Evaluation scale in end-of-life patients (ENP-E scale). RESULTS: 81 patients (average age 65.6 ± 11.7) were studied. At the study's outset, 29.7% employed non-invasive ventilation (NIV), increasing to 51.9% by its conclusion. Initial percutaneous endoscopic gastrostomy (PEG) utilization was 14.8%, rising to 35.85%. Chronic care programme participation was as follows: home care (24.7% initially, 50.6% end), palliative care (16% initially, 40.7% end), case management (13.6% initially, 50.6% end), and advance care planning registration (6.2% initially, 35.8% end). At study start, 47.8% of patients (n = 46) showed moderate-to-severe complexity in PSNs assessment using the ENP-E scale, without showing differences in age, sex, and time of evolution; whereas, on the evolutionary analysis, it was 75% (n = 24). A higher evolutionary complexity was observed in males <60 and >70 years, with no PEG and evolution of ALS of <2 and ≥5 years, and not included in chronicity programmes. When assessing concerns, physical pain and family aspects stand out in all measurements. Forty-eight percent of patients at study start and 71% at end of study showed external signs of emotional distress. SIGNIFICANCE OF RESULTS: Most ALS patients showed a high degree of complexity and were not integrated in chronicity programmes. A "care path" is proposed to integrate ALS patients in these programmes and systematically assess their needs.
Amyotrophic Lateral Sclerosis , Humans , Amyotrophic Lateral Sclerosis/psychology , Amyotrophic Lateral Sclerosis/therapy , Amyotrophic Lateral Sclerosis/complications , Male , Spain , Female , Aged , Middle Aged , Longitudinal Studies , Palliative Care/methods , Palliative Care/statistics & numerical data , Palliative Care/standards , Palliative Care/psychology , Needs Assessment/statistics & numerical data , Aged, 80 and over , Surveys and Questionnaires , Terminal Care/methods , Terminal Care/psychology , Terminal Care/statistics & numerical data , Terminal Care/standards
BACKGROUND: It is known that standardized incidence rates of hip fracture vary among older people in Spain. So far, the results published on the validation of the FRAX® tool in Spain have suggested that the major osteoporotic fractures (MOFs) risk in our country is underestimated. These studies have practically been based on Spanish cohorts evaluated in Catalonia, a higher hip fracture rate area. The purpose of this study is to analyse the ability of the FRAX® in a Spanish mid-fracture rate population. METHODS: Study design: Retrospective cohort study. MEASURES: MOFs: hip, humerus, wrist, spine fractures. Risk of fracture assessed by calculating odds ratios (ORs). Predictive capacity of FRAX® according to the osteoporotic fractures observed between 2009 and 2018 (ObsFr) to predicted by FRAX® without densitometry in 2009 (PredFr) ratio. RESULTS: 285 participants (156 women, 54.7%) with a mean ± SD of 61.5 ± 14 years. Twenty-four people sustained 27 fractures (15 MOFs). Significant ORs were observed for an age ≥ 65 (2.92; 95% CI, 1.07-7.96), female sex (3.18; 95% CI, 1.24-8.16), rheumatoid arthritis (0.62; 95% CI, 2.03-55.55), proton pump (2.71; 95% CI, 1.20-6.09) and serotonin reuptake (2.51; 95% CI, 1.02-6.16) inhibitors. The ObsFr/PredFr ratio in women were 1.12 (95% CI, 0.95-1.29) for MOFs and 0.47 (95% CI, 0-0.94) for hip fractures. Men had a ratio of 0.57 (95% CI, 0.01-1.14) for MOF, no hip fractures were observed. The ratios for the overall group were 1.29 (95% CI, 1.12-1.48) for MOFs and 0.70 (95% CI, 0.22-1.17) for hip fractures. CONCLUSIONS: FRAX® accurately predicted MOFs in women population with a hip fracture incidence rate close to the national mean compared to previous studies conducted in higher incidence regions in Spain.
Hip Fractures , Osteoporotic Fractures , Male , Humans , Female , Aged , Osteoporotic Fractures/epidemiology , Osteoporotic Fractures/etiology , Risk Factors , Risk Assessment/methods , Bone Density , Retrospective Studies , Hip Fractures/diagnosis , Hip Fractures/epidemiology , Hip Fractures/complications
BACKGROUND: Vertigo is a common medical condition with a broad spectrum of diagnoses which requires an integrated approach to patients through a structured clinical interview and physical examination. The main cause of vertigo in primary care is benign paroxysmal positional vertigo (BPPV), which should be confirmed by a positive D-H positional test and treated with repositioning maneuvers. The objective of this study is to evaluate the effectiveness of Epley's maneuver performed by general practitioners (GPs) in the treatment of BPPV. METHODS/DESIGN: This study is a randomized clinical trial conducted in the primary care setting. The study's scope will include two urban primary care centers which provide care for approximately 49,400 patients. All patients attending these two primary care centers, who are newly diagnosed with benign paroxysmal positional vertigo, will be invited to participate in the study and will be randomly assigned either to the treatment group (Epley's maneuver) or to the control group (a sham maneuver). Both groups will receive betahistine. Outcome variables will be: response to the D-H test, patients' report on presence or absence of vertigo during the previous week (dichotomous variable: yes/no), intensity of vertigo symptoms on a Likert-type scale in the previous week, total score on the Dizziness Handicap Inventory (DHI) and quantity of betahistine taken. DISCUSSION: Positive results from our study will highlight that treatment of benign paroxysmal positional vertigo can be performed by trained general practitioners (GPs) and, therefore, its widespread practice may contribute to improve the quality of life of BPPV patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01969513.
Benign Paroxysmal Positional Vertigo/therapy , Physical Therapy Modalities , Primary Health Care/methods , Benign Paroxysmal Positional Vertigo/diagnosis , Benign Paroxysmal Positional Vertigo/physiopathology , Betahistine/therapeutic use , Clinical Protocols , General Practitioners , Histamine Agonists/pharmacology , Humans , Research Design , Spain , Time Factors , Treatment Outcome , Urban Health Services
Fundamento y objetivo: Las fracturas osteoporóticas conllevan un importante consumo de recursos sanitarios. La densitometría ósea ha sido básica en el manejo de la osteoporosis, pero en la predicción del riesgo absoluto de fractura también son importantes otros factores de riesgo. La Organización Mundial de la Salud (OMS) publicó la herramienta FRAX y la National Osteoporosis Guideline Group (NOGG), más recientemente, los umbrales coste-efectivos para solicitar densitometría. Nuestro objetivo es conocer la capacidad predictiva para detectar osteoporosis del FRAX en nuestra población y conocer cómo se modificarían las derivaciones para densitometría aplicando las guías NOGG. Sujetos y método: Estudio de validación diagnóstica en 1.650 mujeres entre 50 y 90 años, sin tratamiento antirresortivo previo de la cohorte FRIDEX. Se realizó densitometría y cuestionario de factores de riesgo. Se compararon los resultados pre y posdensitometría. Se analizó la curva ROC y el área bajo la curva de FRAX predensitometría para predecir osteoporosis. Se calculó el riesgo FRAX predensitometría aplicando umbrales NOGG para determinar a quién debería habérsele realizado densitometría.Resultados: El área bajo la curva para validez diagnóstica de osteoporosis densitométrica de FRAX predensitometría fue 81,2% para fractura principal y 83,1% para fractura de cadera. Aplicando umbrales NOGG a FRAX predensitometría, se derivarían a densitometría el 25,2% de las realizadas. Si añadimos el 24,2% con fractura previa, llegarían al 49,4% de los casos analizados.Conclusión: FRAX es útil para predecir la presencia de osteoporosis. La utilización de los umbrales de las guías NOGG a la herramienta FRAX reduciría al 50% el número de densitometrías realizadas en nuestra práctica clínica actual (AU)
Background and objective: Osteoporotic fractures involve a significant consumption of health resources. Bone densitometry has been essential in the management of osteoporosis. However, for fracture absolute risk prediction, other important clinical risk factors are also important. WHO published a risk estimation tool (FRAX), and the National Osteoporosis Guideline Group (NOGG) reported thresholds for densitometry assessment based on cost-effectivity criteria. Our goal is to determine the diagnostic predictive validity of FRAX in our population, and to assess how its use (according to NOGG guidelines) would modify the current number of referrals to DXA scan in our health system. Subjects and methods:Diagnostic validation study in a consecutive sample of 1,650 women, 50 to 90 years old, under no treatment with anti-resortives, from the FRIDEX cohort. DXA and a questionnaire regarding risk factors were performed. ROC curve and area under the curve (AUC) were used to assess FRAX's diagnostic validity for femoral neck osteoporosis (FNOP). Risk of fracture was calculated using FRAX pre and postDXA, and women were classified according to their risk, following NOGG recommendations.Results: FRAX's ROC AUC for FNOP was 0.812 for major fracture and 0.832 for hip fracture. Using FRAX according to NOGG would result in performing only 25.2% of the current tests. If we added previous fracture antecedent to the algorithm, 49.4% of the tests performed would be advised.Conclusions: The use of NOGG thresholds applied to FRAX would reduce about 50% the current number of referrals to DXA scan in our population. FRAX has a good diagnostic validity for FNOP (AU)
Humans , Osteoporosis/diagnosis , Fractures, Bone/epidemiology , Osteoporosis/epidemiology , Densitometry , Risk Factors , Bone Density Conservation Agents/therapeutic use
BACKGROUND AND OBJECTIVE: Osteoporotic fractures involve a significant consumption of health resources. Bone densitometry has been essential in the management of osteoporosis. However, for fracture absolute risk prediction, other important clinical risk factors are also important. WHO published a risk estimation tool (FRAX), and the National Osteoporosis Guideline Group (NOGG) reported thresholds for densitometry assessment based on cost-effectivity criteria. Our goal is to determine the diagnostic predictive validity of FRAX in our population, and to assess how its use (according to NOGG guidelines) would modify the current number of referrals to DXA scan in our health system. SUBJECTS AND METHODS: Diagnostic validation study in a consecutive sample of 1,650 women, 50 to 90 years old, under no treatment with anti-resortives, from the FRIDEX cohort. DXA and a questionnaire regarding risk factors were performed. ROC curve and area under the curve (AUC) were used to assess FRAX's diagnostic validity for femoral neck osteoporosis (FNOP). Risk of fracture was calculated using FRAX pre and postDXA, and women were classified according to their risk, following NOGG recommendations. RESULTS: FRAX's ROC AUC for FNOP was 0.812 for major fracture and 0.832 for hip fracture. Using FRAX according to NOGG would result in performing only 25.2% of the current tests. If we added previous fracture antecedent to the algorithm, 49.4% of the tests performed would be advised. CONCLUSIONS: The use of NOGG thresholds applied to FRAX would reduce about 50% the current number of referrals to DXA scan in our population. FRAX has a good diagnostic validity for FNOP.
Absorptiometry, Photon , Osteoporosis/diagnosis , Algorithms , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Osteoporosis/complications , Osteoporosis/epidemiology , Osteoporotic Fractures/epidemiology , Osteoporotic Fractures/etiology , Predictive Value of Tests , Risk Assessment , Spain
