A New Quantitative Approach to Assessing Noncompliance With Medical Recommendations in Heart Transplant Recipients.

BACKGROUND: Failure of compliance with medical regimen is one of the major risk factors associated with morbidity and mortality in heart transplant (HT) recipients. Nevertheless, to date, there is no specific, gold-standard, comprehensive set of tools for assessing compliance in these patients. OBJECTIVE: The objective of the present study was to develop a specific instrument for the assessment of noncompliance with medical recommendations in HT recipients. METHODS: This prospective observational study used a nonprobability sampling method, which was performed from January 2006 to December 2012. All of the patients met clinical criteria for being included on the waiting list for a HT. We designed a scale for measuring the compliance degree at 12 months after heart transplantation. This scale included the most important aspects of the medical regimen, using nine discrete quantitative variables. The total score was described as the patient's Noncompliance Factor (NCF). The results were analysed by mean, ranks, and percentages. RESULTS: The sample was constituted of 61 participants who underwent surgical HT intervention and completed the 12-month follow-up assessment. The overall incidence of noncompliance was around 30% and only 43.1% of the recipients had an acceptable degree of compliance. CONCLUSIONS: The overall incidence of noncompliance in HT recipients is high and this can generate worse clinical outcomes. Evaluation by specific screening instruments like the one proposed in the present study can be useful for a systematic detection of this phenomenon.

Longitud (número de preguntas) y resultado de un examen / Length (number of questions) and exams results

Objetivo. Este artículo presenta dos estudios sobre la relación entre el número de preguntas de un examen y sus resultados. Estos dos estudios se realizaron en respuesta a dos problemas concretos presentados en dos facultades de ciencias de la salud de dos universidades catalanas. Sujetos y métodos. El primer estudio, realizado en la Facultad de Medicina de la Universitat Autònoma de Barcelona, compara los resultados reales obtenidos en pruebas de elección múltiple en tres asignaturas con los resultados que hubieran obtenido los estudiantes con la mitad de las preguntas. La dificultad del examen en ambas situaciones fue prácticamente la misma y los resultados académicos también fueron similares. El segundo estudio, llevado a cabo en la Facultad de Ciencias de la Salud y de la Vida de la Universitat Pompeu Fabra de Barcelona, compara los resultados reales obtenidos en pruebas de ensayo de dos asignaturas de los estudios de Biología con los hipotéticos que se hubieran obtenido con la mitad de las preguntas. Los resultados obtenidos globalmente fueron muy parecidos. Conclusión. La conclusión general del estudio es que la evaluación del rendimiento académico no dependería fundamentalmente del número de preguntas y que sería más importante buscar la representatividad y relevancia de éstas (AU)

Aim. This paper resents two studies about the relationship between the number of questions that appear in an exam and their results. These studies have been done in response to two concrete problems found in two Spanish universities. Subjects and methods. The first study, done at the Faculty of Medicine of the Autonomous University of Barcelona, compared the real results achieved in three subjects which use MCQ-tests with the theoretical results which the students would have achieved if half of the questions had been used. The difficulty of the exams in both situations was practically the same and the student’s academic results were very similar in both situations. The second study, carried out at the Faculty of Health and Life Sciences at the Pompeu Fabra University of Barcelona, compared the real academic results in two subjects which use free response questions with the supposed ones with half of the questions of the exam in two subjects which use many essay questions. The results obtained by the students were practically identical. Conclusion. Our general conclusion is that in the evaluation of academic performance, it is more important how relevant and representative the questions are than the number of them (AU)

Study on the efficacy and tolerability of amisulpride in medical/surgical inpatients with delirium admitted to a general hospital.

PURPOSE: To evaluate the efficacy and safety of amisulpride in medical inpatients who present with delirium. METHOD: Open label prospective study with 7-day follow-up. Forty hospital inpatients with delirium were recruited, seven of whom died and two of whom refused medication. The average dose of amisulpride for delirium treatment was 200-300 mg/day. Daily assessments were performed with Delirium Rating Scale (DRS), Positive Subscale of the Positive and Negative Syndrome Scale (PANSS-P), Mini Mental State Examination (MMSE), Neurological Subscale of the UKU side effect rating scale. Variance analysis was performed through repeated measurements, with the general linear model with paired comparisons and Bonferroni correction for each measured variable. RESULTS: Patients showed significant improvement on the DRS from the first day of treatment DRS = 17.55 until day 7 DRS = 7.26 (F = 92.485; p < 0.001), psychotic symptoms improved from first day PANSS-P = 18.26 to last day PANSS-P = 9.35 (F = 144.83; p < 0.001). Cognitive status showed a significant improvement from day 2 MMSE = 18.71 until day 7 MMSE = 24.06 (F = 96.56; p < 0.001), and the neurological subscale of the UKU side effect rating scale showed a significant improvement the last day with respect to baseline pretreatment level (F = 7.539; p = 0.01). CONCLUSIONS: These results suggest a good response to amisulpride in the acute phase of delirium, although further randomized controlled studies must be performed.

[Psychiatric disease in patients with psychogenic non-epileptic seizures referred from an epilepsy unit in a general hospital]. / Patología psiquiátrica en pacientes con crisis no epilépticas psicógenas derivados a una unidad de epilepsia en un hospital general.

INTRODUCTION: We evaluate psychiatric disease associated with psychogenic non-epileptic seizures (PNES) and study the role played by previous traumatic experiences, dissociative episodes and personality disorders. METHOD: After diagnosing PNES in our epilepsy unit, we obtained a sample of 46 patients and carried out a structured psychiatric interview (SCID) following DSM-III-R criteria. We looked for previous dissociative episodes and prepared a questionnaire for traumatic experiences and basic clinical data. RESULTS: The most frequent psychiatric disorders were depression, anxiety and somatoform disorders. Personality disorders were found in 16 patients (34.78%), dissociative episodes in 17 (36.95%), and previous traumatic experiences in 14 (30.43%). No statistically significant differences were found in regards to PNES, with respect to presence or absence of previous traumatic experiences, dissociative episodes, and personality disorders. CONCLUSIONS: As in previous studies, our research project confirms the co-existence of PNES with other mental disorders, and although we do find a higher frequency of seizures, the role played by traumatic experiences and dissociative disorders in CNEP remains unclear.

Patología psiquiátrica en pacientes con crisis no epilépticas psicógenas derivados a una unidad de epilepsia en un hospital general / Psychiatric disease in patients with psychogenic non-epileptic seizures referred from an epilepsy unit in a general hospital

Introducción. Se evalúa la patología psiquiátrica que acompaña a las crisis no epilépticas psicógenas (CNEP) y se estudia el papel que desempeñan en ellas las experiencias traumáticas previas, los episodios disociativos y los trastornos de la personalidad. Método. Después del diagnóstico de CNEP en la Unidad de Epilepsia de nuestro centro se realizó en una muestra de 46 pacientes una entrevista psiquiátrica estructurada siguiendo criterios DSM-III-R (SCID). Se evaluó la existencia de episodios disociativos siguiendo criterios DSM-IV, y para las experiencias traumáticas y los datos clínicos de interés se confeccionó un cuestionario ad hoc. Resultados. Los trastornos psiquiátricos más frecuentes fueron los estados depresivos, los de ansiedad y los somatomorfos. Presentaban trastornos de la personalidad 16 pacientes (34,78 por ciento), fenómenos disociativos 17 pacientes (3695 9ó) y 14 pacientes (30,43 por ciento) antecedentes de experiencias traumáticas. No se observaron diferencias estadísticamente significativas en relación con las CNEP, respecto a la presencia o ausencia de experiencias traumáticas previas, trastornos disociativos o trastornos de la personalidad. Conclusiones. Como en trabajos previos, en nuestro estudio se confirma la existencia de una gran comorbilidad psiquiátrica en relación con las CNEP, y aunque asociadas a la presencia de un mayor número de crisis, el papel que tienen las experiencias traumáticas y los trastornos disociativos en relación con las CNEP permanece poco claro (AU)