Satisfacción en la Unidad de Cuidados Intensivos (UCI): la opinión del paciente como piedra angular / Satisfaction in the Intensive Care Unit (ICU). Patient opinion as a cornerstone

OBJETIVO: Estudiar la concordancia entre los grados de satisfacción de los pacientes y sus familiares (ambos pertenecientes a un mismo núcleo familiar) en cuanto a los cuidados y atenciones proporcionados durante su estancia en la UCI. DISEÑO: Estudio transversal, observacional, descriptivo y prospectivo durante 5 meses. Ámbito: UCI del Hospital Universitario Marqués de Valdecilla de Santander. Sujetos: Pacientes mayores de 18 años con estancia mayor de 24h que fueron dados de alta de la UCI durante el período de estudio y familiares de dichos pacientes. Intervención: Instrumento: cuestionario FS-ICU 34 para evaluar la satisfacción de los familiares de pacientes ingresados en la UCI y adaptación de dicho cuestionario para el paciente. Se determina el grado de concordancia mediante el índice de kappa ponderado para muestras pareadas. RESULTADOS: Se analizaron todos los cuestionarios procedentes de un mismo núcleo familiar, obteniéndose un total de 148 pares de cuestionarios (296 encuestas). Se obtuvieron índices kappa que oscilaron entre 0,278 y 0,558, lo que indica grados de concordancia entre débiles y moderados. CONCLUSIONES: Los familiares de los pacientes ingresados en la UCI no pueden ser considerados unos representantes adecuados, al menos para el subgrupo de pacientes competentes. En estos casos debemos acudir a esos pacientes para conocer de primera mano sus sentimientos, percepciones y vivencias durante su estancia en la UCI. Solo cuando los pacientes no están en condiciones de participar activamente en el proceso asistencial debemos acudir a sus familias

OBJECTIVE: To study the agreement between the level of satisfaction of patients and their families referred to the care and attention received during admission to the ICU. DESIGN: A prospective, 5-month observational and descriptive study was carried out. SETTING: ICU of Marqués de Valdecilla University Hospital, Santander (Spain). Subjects: Adult patients with an ICU stay longer than 24h, who were discharged to the ward during the period of the study, and their relatives. Intervention: Instrument: FS-ICU 34 for assessing family satisfaction, and an adaptation of the FS-ICU 34 for patients. The Cohen kappa index was calculated to assess agreement between answers. RESULTS: An analysis was made of the questionnaires from one same family unit, obtaining 148 pairs of surveys (296 questionnaires). The kappa index ranged between 0.278-0.558, which is indicative of mild to moderate agreement. CONCLUSIONS: The families of patients admitted to the ICU cannot be regarded as good proxies, at least for competent patients. In such cases, we must refer to these patients in order to obtain first hand information on their feelings, perceptions and experiences during admission to the ICU. Only when patients are unable to actively participate in the care process should their relatives be consulted

Gender-associated comorbidities in rheumatoid arthritis and their impact on outcome: data from GENIRA.

GENIRA [Gender in Rheumatoid Arthritis (RA)] is a comprehensive project aimed at studying gender differences in RA patients and how these differences impact on these patient outcomes. We are now reporting such data. Seventy RA patients of each gender were cross-sectionally evaluated following a preestablished protocol. Univariate and multivariate analyses focused in the different gender-associated comorbidity profiles and how they impact in the quality of life and disability of RA patients as assessed by the SF-36 and the Modified Health Assessment Questionnaire (M-HAQ), respectively. Both groups were comparable regarding their main demographic and clinical features. Different comorbidity profiles were found in both genders, with higher frequencies of diabetes mellitus, peptic ulcer, ischemic heart disease, smoking and chronic obstructive pulmonary disease among men and of depression and osteoporosis among women. The M-HAQ was lower in women than in men (0.89 ± 2.6 vs 0.22 ± 0.9, p = 0.04) as there were some sub-scales of the SF-36 [mental health (63.7 ± 22.0 vs 71.8 ± 21.1; p = 0.02), general health (41.3 ± 21.7 vs 50.0 ± 24.3; p = 0.02), physical functioning (PF) (57.7 ± 22.1 vs 67.3 ± 22.7; p = 0.01) and the physical summary component (PSC) (39.3 ± 8.9 vs 42.4 ± 9.3, p = 0.04)]. Multivariate analysis indicated the independent association between depression and osteoporosis rather than gender with the M-HAQ, PSC and PF and of only depression with the MH and GH. Women with RA present significantly worse disability and QOL outcomes than men; these differences can be explained by female gender-associated comorbidities such as depression and osteoporosis rather than gender per se.

Satisfaction in the Intensive Care Unit (ICU). Patient opinion as a cornerstone. / Satisfacción en la Unidad de Cuidados Intensivos (UCI): la opinión del paciente como piedra angular.

OBJECTIVE: To study the agreement between the level of satisfaction of patients and their families referred to the care and attention received during admission to the ICU. DESIGN: A prospective, 5-month observational and descriptive study was carried out. SETTING: ICU of Marqués de Valdecilla University Hospital, Santander (Spain). SUBJECTS: Adult patients with an ICU stay longer than 24h, who were discharged to the ward during the period of the study, and their relatives. INTERVENTION: Instrument: FS-ICU 34 for assessing family satisfaction, and an adaptation of the FS-ICU 34 for patients. The Cohen kappa index was calculated to assess agreement between answers. RESULTS: An analysis was made of the questionnaires from one same family unit, obtaining 148 pairs of surveys (296 questionnaires). The kappa index ranged between 0.278-0.558, which is indicative of mild to moderate agreement. CONCLUSIONS: The families of patients admitted to the ICU cannot be regarded as good proxies, at least for competent patients. In such cases, we must refer to these patients in order to obtain first hand information on their feelings, perceptions and experiences during admission to the ICU. Only when patients are unable to actively participate in the care process should their relatives be consulted.

Medición de la satisfacción de los pacientes ingresados en unidad de cuidados intensivos y sus familiares / Measuring the satisfaction of patients admitted to the intensive care unit and of their families

Objetivo: Conocer el grado de satisfacción de los familiares de los pacientes dados de alta de la UCI y el del propio paciente. Diseño: Estudio transversal, observacional, descriptivo y prospectivo durante 5 meses. Ámbito: UCI del Hospital Universitario Marqués de Valdecilla de Santander. Sujetos: Familiares y pacientes que fueron dados de alta de la UCI durante ese período. Intervención Instrumento: encuesta Family Satisfaction Intensive Care Unit (FS-ICU 34) para familiares de pacientes ingresados en UCI (que sobrevivieron o no) y adaptación de la FS-ICU en cuanto a cuidados se refiere, para el propio paciente. Resultados: Se obtuvieron un total de 385 encuestas, 192 de familiares de supervivientes, 31 de familiares de fallecidos y 162 de pacientes. La mayor parte de los familiares encuestados estaban satisfechos con los cuidados recibidos y el proceso de decisiones (supervivientes: 83,46 ± 11,83 y 79,42 ± 13,58, respectivamente; fallecidos: 80,4 ± 17,27 y 79,61 ± 16,93, respectivamente). Los pacientes encuestados estaban muy satisfechos con los cuidados recibidos (84,71 ± 12,85). Conclusiones: El grado de satisfacción de los familiares y de los propios pacientes ingresados en la UCI es elevado. Aun así, existen varios puntos que deberían ser mejorados, como el ambiente de la sala de espera y el ambiente propio de la UCI en cuanto a ruido, intimidad e iluminación se refiere, así como algunos aspectos del proceso de toma de decisiones, entre ellos la esperanza suministrada acerca de la recuperación de su familiar

Objective: To determine the level of satisfaction of family members with the care and decision making process, and to know the level of satisfaction of patients discharged from ICU. Design: A prospective, observational and descriptive study with a duration of 5 months was carried out. Setting The ICU of Marqués de Valdecilla University Hospital, Santander (Spain).Subjects Family members of adult patients admitted to the ICU and patients discharged to the ward. Intervention Instrument: Family Satisfaction Intensive Care Survey (FS-ICU 34) of family members of patients discharged to the ward. We adapted the FS-ICU 34 in relation to care for application to the patients. Results: A total of 385 questionnaires were obtained: 192 from families of survivors and 162 from patients, and 31 from relatives of non-survivors. The majority of relatives were satisfied with overall care and overall decision making (survivors: 83.46±11.83 and 79.42 ± 13.58, respectively; non-survivors: 80.41 ± 17.27 and 79.61 ± 16.93, respectively). Patients were very satisfied with the care received (84.71 ± 12.85). Conclusions: The level of satisfaction of the relatives of patients admitted to the ICU is high, in the same way as the degree of patient satisfaction. Still, there are several points that should be improved, such as the waiting room environment and the atmosphere of the ICU in terms of noise, privacy and lighting. In relation to the decision making process, there are also some aspects that may be improved, such as the provision of hope regarding recovery of the critically ill relative

[Measuring the satisfaction of patients admitted to the intensive care unit and of their families]. / Medición de la satisfacción de los pacientes ingresados en unidad de cuidados intensivos y sus familiares.

OBJECTIVE: To determine the level of satisfaction of family members with the care and decision making process, and to know the level of satisfaction of patients discharged from ICU. DESIGN: A prospective, observational and descriptive study with a duration of 5 months was carried out. SETTING: The ICU of Marqués de Valdecilla University Hospital, Santander (Spain). SUBJECTS: Family members of adult patients admitted to the ICU and patients discharged to the ward. INSTRUMENT: Family Satisfaction Intensive Care Survey (FS-ICU 34) of family members of patients discharged to the ward. We adapted the FS-ICU 34 in relation to care for application to the patients. RESULTS: A total of 385 questionnaires were obtained: 192 from families of survivors and 162 from patients, and 31 from relatives of non-survivors. The majority of relatives were satisfied with overall care and overall decision making (survivors: 83.46 ± 11.83 and 79.42 ± 13.58, respectively; non-survivors: 80.41 ± 17.27 and 79.61 ± 16.93, respectively). Patients were very satisfied with the care received (84.71 ± 12.85). CONCLUSIONS: The level of satisfaction of the relatives of patients admitted to the ICU is high, in the same way as the degree of patient satisfaction. Still, there are several points that should be improved, such as the waiting room environment and the atmosphere of the ICU in terms of noise, privacy and lighting. In relation to the decision making process, there are also some aspects that may be improved, such as the provision of hope regarding recovery of the critically ill relative.

[Differences in the quality of Spanish clinical trials published in international periodicals and of the ones presented in general medicine periodicals with wide readership]. / Diferencias en la calidad de los ensayos clínicos españoles publicados en revistas internacionales y los aparecidos en revistas generales de medicina de gran difusión.

BACKGROUND: The assessment of the methodological quality of controlled clinical trials (CCTs) carried out in Spain and published in international journals and the comparison with those published in widely read general journals of medicine (N Engl J Med, Lancet, JAMA, BMJ) may help establishing their limitations and improving quality in future studies. METHODS: Search in Medline of CCTs. Studies were evaluated according to a structured questionnaire (J Clin Epidemiol 1992; 45:225-265). The odds ratio and their 95% confidence intervals were used to compare spanish studies with the remaining studies. The following variables were considered as confounders and controlled for by logistic regression analysis: number of participating centers, sample size, funding source, and the inclusion of epidemiologists in the research team. The journal's impact factor was taken into account. RESULTS: Spanish CTTs had a smaller sample size, were mostly monocentric, reported les frequently the source of funding, and exhibited a lower participation of epidemiologists. The informed consent and the approval by the ethics committee were more frequently omitted. The major methodological differences with the other studies were: lack of pre-study sample size and statistical power estimation, lack of inclusion criteria, poor explanation of patients' flow in the selection process, lack of explanation for unmasked procedures, poor description of methods to assess intervention compliance, under-reporting confidence intervals, and less frequent use of the intention-to-treat principle. The quality score of spanish studies was lower (9.4 +/- 1.7 vs 10.7 +/- 1.5; p < 0.001). These limitations improved with higher journal's impact factor, the quality score was 8.5 in journals with an impact factor < 1.5, and 10.6 in those with an impact factor > 4.5. This last figure is almost identical to the average of CCTs published in general journals of medicine. CONCLUSIONS: Most spanish studies achieved a good quality score. Nevertheless, there are still issues which can be overcome easily. If this goal is achieved, the results will obtain a higher repercussion, as a better quality is observed in those published in journals with the highest impact factor.

Diferencias en la calidad de los ensayos clínicos españoles publicados en revistas internacionales y los aparecidos en revistas generales de medicina de gran difusión / Differences in quality between spanish clinical trials published in international journals and foreign trials published in worldwide read medical journals

Fundamento. La comparación de la calidad metodológica de los ensayos clínicos controlados (ECC) españoles publicados en revistas internacionales con la de los ensayos foráneos aparecidos en las revistas generales de medicina de mayor difusión (N Engl J Med, Lancet, JAMA, BMJ) puede ayudar a establecer las deficiencias existentes y contribuir a lograr una mayor calidad de los estudios futuros. Métodos. Búsqueda en Medline de los ECC. Los estudios se evaluaron mediante un protocolo estructurado (J Clin Epidemiol 1992; 45:255-265). Para comparar los estudios españoles con el resto se utilizaron las odds ratio y sus intervalos de confianza del 95 por ciento. Se identificaron como factores de confusión el carácter multicéntrico, el tamaño del estudio, la existencia de financiación y la participación de epidemiólogos. Estos factores se controlaron mediante regresión logística. Se hizo un análisis en función del factor del impacto de la revista. Resultados. Los estudios españoles tuvieron un menor tamaño, fueron mayoritariamente unicéntricos y era menos frecuente que describiesen su fuente de financiación. En ellos era menor la participación de epidemiólogos. También mencionaron con menor frecuencia la obtención del consentimiento informado y la aprobación por un Comité Ético. Las mayores diferencias metodológicas radicaron en la falta de predeterminación del tamaño muestral y de la potencia estadística, la carencia de criterios de inclusión, la escasa explicitación del flujo de pacientes en la selección, la falta de justificación de ensayos abiertos (no enmascarados), la insuficiente descripción de los métodos para valorar el cumplimiento de la intervención, el escaso uso de los intervalos de confianza y la menos frecuente aplicación del principio de intención de tratar. Lo anterior se refleja en una menor puntuación de calidad metodológica de los estudios españoles (9,4 ñ 1,7 frente a 10,7 ñ 1,5, p < 0,001).Estas deficiencias mejoraron conforme el impacto de la revista fue mayor, la puntuación de calidad pasó de 8,5 en las revistas con impacto < 1,5 a 10,6 en las de más de 4,5 de impacto. Este ultimo valor es casi idéntico al de los ensayos publicados en las revistas generales de medicina. Conclusiones. La mayoría de los ensayos españoles alcanzaron una puntuación de calidad buena; no obstante, aún existen aspectos fácilmente mejorables. Superarlos conduciría a una mayor repercusión de sus resultados, ya que se encuentra una mejor calidad en los publicados en las revistas de mayor impacto (AU)

[Comparison between several standard populations for age-adjusting]. / Comparación entre varias poblaciones estándar para el ajuste por edades.

BACKGROUND: To analyse the effect the choice of reference population has on different indicators derived from mortality rates age-adjusting. METHODS: The mortality rates for different causes of death in Spain from 1971 to 1992 were adjusted by using four reference populations: Spanish populations from 1971 and 1992, the Standard European population and the standard world population. The results obtained with the four populations were compared by applying three indicators: difference between the rates of 1992 and 1971, ratio between the rates of 1992 and 1971 and annual percentage change between 1971 and 1992. RESULTS: In the majority of the causes of death studied, including the total, ischemic heart disease and almost all of the tumours, the ratio between the rates and the percentage of annual change are similar regardless of the standard population used. However, the difference in rates is very noticeable in relation to the reference population. In the infectious diseases and testis cancer, the opposite occurs: the different in rates is steadfast while the ratio between the rates varies with the standard population. Finally, the mortality due to pneumonia, Parkinson's disease and encephalic cancer show changes all three indicators used. CONCLUSIONS: An analysis of the specific rates by age must be made before proceeding with their adjustment. This analysis will enable us to ascertain whether the adjustment by age is correct and which indicator (difference, ratio or percentage change) will be appropriate for making comparisons.

[Hepatitis B vaccination. Indications of the post-vaccine serologic test and booster doses]. / Vacunación de la hepatitis B. Indicaciones del test serológico postvacunal y la dosis de refuerzo.

The standard anti-HBV vaccination elicits protective anti-HBs levels (above 10 UI/l) in most people. However, the effective duration of immunologic memory is not well-known. Consequently, the recommendations on the postvaccination follow-up are not uniform: from vaccination with no follow-up blood test (anti-HBs levels) to regular follow-up blood tests for all vaccines. In unresponsive subjects a booster dose has been demonstrated to be effective. However, the optimal procedure for management depending anti-HBs levels has not been well established. Postvaccination antibody testing and regular testing for antibodies is recommended only to high-risk subjects, especially to health care workers and subjects with immunodeficiency. In these cases, the booster dose should be administered in nonresponders, and might include double doses. Unanimous consensus does not exist about to the appropriate timing for booster dose administration.

[Analysis of the cohort effect on the trend in mortality from motor neuron disease in Spain, 19551-1002]. / Análisis del effecto de cohorte en la evolución de la mortalidad por enfermedad de la motoneurona en España, 1951-1992.

BACKGROUND: An increase in the mortality due to motor neuron disease (MND) has been reported in Spain over the past 30-40 years. It has been suggested that this increase is due to the cohort effect, but his hypothesis has not been proven. METHODS: The motor neuron disease (MND) mortality statistics by age and by gender were furnished from the Spanish National Institute of Statistics. The mortality specifically by age and the adjusted age-related rates were calculated. By Poisson regression, the cohort effect of birth on the mortality by ages has been analyzed, the cohort effect also having been analyzed by graphic methods. RESULTS: The mortality adjusted by age was declining up until 1969, as of which time it has been on the rise. Each five-year birth cohort increases the risk of dying from MND by 8.5%. CONCLUSIONS: The increase in the mortality due to MND in Spain is the result of a cohort effect.

[Gompertzian analysis of mortality due to lung cancer in Spain, 1968-1995]. / Análisis gompertziano de la mortalidad por cáncer de pulmón en España, 1968-1995.

OBJECTIVE: To analyse lung cancer mortality trend in Spain from 1968 to 1995, distinguishing effects due to environmental and competing factors. METHODS: Age-standardised mortality rates from lung cancer are estimated using a world standard population. A graphical analysis of age, period, and cohort effects is made. Environmental and competing factors influencing in lung cancer mortality are quantify mediant the Gompertzian longitudinal analysis. RESULTS: Lung cancer mortality increased from 1968 to 1995 in Spanish men; in women, it rests nearly constant to 1989 but a light increase is shown from 1989 on. A cohort effect in men is appreciated but no detectable effect in women is shown by the age, period, and cohort analysis. Lung cancer in Spain is a Gompertzian disease with intersection point in 66 years for men and 76 years for women. Competing factors remained constant and environmental factors increased in men throughout the studied period. However, competing factor decreased in women to 1992, causing a decrease in mortality rates under 76 years; environmental factors remain constant in women. CONCLUSIONS: The evolution of environmental factors is responsible of the main part of changes in lung cancer mortality in men, and treatment improvements have had a little influence. In women, competing risks, probably the increase in breast cancer mortality, have prevent a increase in lung cancer mortality.

[The effect of myocardial infarct on the employment situation of patients]. / Impacto del infarto de miocardio en la situación laboral de los pacientes.

INTRODUCTION AND OBJECTIVES: The impact of acute myocardial infarction in labour activity changes from one country to another as well as patients' characteristics. Our purpose was aimed to learn the main demographic, professional, clinical and therapeutic variables which might affect the return to work after suffering a myocardial infarction in our environment. METHODS: 584 patients treated consecutively in our Coronary Unit for 4 years, aged under 65, were studied. The following aspects were analyzed: age, sex, previous ischaemic heart disease, previous working condition, professional level, economical area of labour activity, main therapeutic procedures and complications, number of days of sick leave, posterior labour status and date of invalidity or death, should it occur. The minimum follow up period was two years. RESULTS: 65.3% of patients were regularly working before suffering the myocardial infarction. Mean length of sick leave after myocardial infarction was 243.9 days although it changed according to age and economical areas. 56.6% of the patients returned to work according to age (odds ratio = 0.92), high professional status (odds ratio = 2.14), economical area of services (odds ratio = 2.03), and the presence of previous anginal attacks (odds ratio = 1.73). CONCLUSIONS: In our environment, patients less likely to resume their work after suffering a myocardial infarction are older, working in agricultural and industrial areas, with a lower professional level and without known ischemic heart disease antecedents.