Healthcare experience among patients with type 2 diabetes: A cross-sectional survey using the IEXPAC tool.

Aim: To assess the experience with health care among patients with type 2 diabetes (T2DM) and to evaluate patients' demographic variables and healthcare-related characteristics which may affect their experience. Methods: A cross-sectional survey was delivered to T2DM adults. Patient experiences were assessed with the 'Instrument for Evaluation of the Experience of Chronic Patients' (IEXPAC) questionnaire, a validated 12-item survey, which describes patient experience within the last 6 months (items 1-11) and hospitalization in the last 3 years (item 12), with possible scores ranging from 0 (worst) to 10 (best experience). Results: A total of 451 T2DM patients responded to the survey (response rate 72.3%; mean age 69.5 ± 10.1 years, 67.8% men). The mean overall IEXPAC score was 5.92 ± 1.80. Mean scores were higher for productive interactions (7.92 ± 2.15) and self-management (7.08 ± 2.27) than for new relational model (1.72 ± 2.01). Only 32.8% of patients who had been hospitalized in the past 3 years reported having received a follow-up call or visit after discharge. Multivariate analyses identified that regular follow-up by the same physician and follow-up by a nurse were associated with a better patient experience. Continuity of healthcare score was higher only in those patients requiring help from others. Conclusions: The areas of T2DM care which may need to be addressed to ensure better patient experience are use of the Internet, new technologies and social resources for patient information and interaction with healthcare professionals, closer follow-up after hospitalization, and a comprehensive multidisciplinary approach with regular follow-up by the same physician and a nurse.

Symtuza® (DRV/c/FTC/TAF) in the management of previously treated patients. / Symtuza® (DRV/c/FTC/TAF) en el abordaje de pacientes que han recibido tratamiento antirretroviral previamente.

Because of the development of antiretroviral therapy (ART) in the last few years, we now have safe, effective short- and long-term options and also simple regimens, with most combinations being administered once daily in one or 2 tablets and almost no treatment failures. Nevertheless, there are still reasons to switch an effective ART in patients who have been suppressed, a switch that must always be made without losing virological efficacy. With longer survival and the need for lifelong treatment, it is important to have simple and safe treatment options to improve the quality of life in patients with HIV. The EMERALD clinical trial demonstrates the non-inferiority of the switch to Symtuza®, a combination of darunavir, cobicistat, emtricitabine and tenofovir alafenamide in a single tablet, in patients with sustained viral suppression. Supplement information: This article is part of a supplement entitled "Co-formulated cobicistat-boosted darunavir, emtricitabine, and tenofovir alafenamide for the treatment of HIV infection", which is sponsored by Janssen.

Symtuza(R) (DRV/c/FTC/TAF) en el abordaje d epacientes que han recibido tratamiento antirretroviral previamente / Symtuza(R) (DRV/c/FTC/TAF) in the management of previously treated patients

La evolución del tratamiento antirretroviral (TAR) en los últimos años ha permitido que se disponga de opciones seguras, eficaces a corto y a largo plazo, y también sencillas hasta el punto de que la mayoría de las combinaciones se administran una vez al día, se concentran en uno o 2 comprimidos, y apenas existen fracasos terapéuticos. Pese a todo, continúan existiendo motivos para el cambio de un TAR eficaz en pacientes inmunodeprimidos, cambio que siempre se debe realizar sin perder la eficacia virológica. Con el aumento de la supervivencia en los últimos años y la necesidad de tratamiento de por vida, es importante disponer de pautas simples y seguras para mejorar la calidad de vida de los pacientes con VIH. El ensayo clínico EMERALD demuestra la no inferioridad del cambio a Symtuza(R), combinación de darunavir, cobicistat, em-tricitabina y tenofovir alafenamida en un solo comprimido, en pacientes con supresión viral mantenida. Información sobre el suplemento: este artículo forma parte del suplemento titulado "Darunavir, cobicistat, emtricitabina y tenofovir alafenamida coformulados en el tratamiento de la infección por el VIH", que ha sido patrocinado por Janssen

Because of the development of antiretroviral therapy (ART) in the last few years, we now have safe, effective short- and long-term options and also simple regimens, with most combinations being administered once daily in one or 2 tablets and almost no treatment failures. Nevertheless, there are still reasons to switch an effective ART in patients who have been suppressed, a switch that must always be made without losing virological efficacy. With longer survival and the need for lifelong treatment, it is important to have simple and safe treatment options to improve the quality of life in patients with HIV. The EMERALD clinical trial demonstrates the non-inferiority of the switch to Symtuza(R), a combination of darunavir, cobicistat, emtricitabine and tenofovir alafenamide in a single tablet, in patients with sustained viral suppression. Supplement information: This article is part of a supplement entitled "Co-formulated cobicistat-boosted darunavir, emtricitabine, and tenofovir alafenamide for the treatment of HIV infection", which is sponsored by Janssen

[Consensus statement on metabolic disorders and cardiovascular risks in patients with human immunodeficiency virus]. / Documento de consenso sobre alteraciones metabólicas y riesgo cardiovascular en pacientes con infección por el virus de la inmunodeficiencia humana.

OBJECTIVE: This consensus document is an update of metabolic disorders and cardiovascular risk (CVR) guidelines for HIV-infected patients. METHODS: This document has been approved by an expert panel of GEAM, SPNS and GESIDA after reviewing the results of efficacy and safety of clinical trials, cohort and pharmacokinetic studies published in biomedical journals (PubMed and Embase) or presented in medical scientific meetings. Recommendation strength and the evidence in which they are supported are based on the GRADE system. RESULTS: A healthy lifestyle is recommended, no smoking and at least 30min of aerobic exercise daily. In diabetic patients the same treatment as non-HIV infected patients is recommended. HIV patients with dyslipidemia should be considered as high CVR, thus its therapeutic objective is an LDL less than 100mg/dL. The antihypertensive of ACE inhibitors and ARAII families are better tolerated and have a lower risk of interactions. In HIV-patients with diabetes or metabolic syndrome and elevated transaminases with no defined etiology, the recommended is to rule out a hepatic steatosis Recommendations for action in hormone alterations are also updated. CONCLUSIONS: These new guidelines update previous recommendations regarding all those metabolic disorders involved in CVR. Hormone changes and their management and the impact of metabolic disorders on the liver are also included.

Executive summary of the consensus document on metabolic disorders and cardiovascular risk in patients with HIV infection.

The importance of the metabolic disorders and their impact on patients with HIV infection requires an individualized study and continuous updating. HIV patients have the same cardiovascular risk factors as the general population. The HIV infection per se increases the cardiovascular risk, and metabolic disorders caused by some antiretroviral drugs are added risk factors. For this reason, the choice of drugs with a good metabolic profile is essential. The most common metabolic disorders of HIV infected-patients (insulin resistance, diabetes, hyperlipidemia or osteopenia), as well as other factors of cardiovascular risk, such as hypertension, should also be dealt with according to guidelines similar to the general population, as well as insisting on steps to healthier lifestyles. The aim of this document is to provide a query tool for all professionals who treat HIV-patients and who may present or display any metabolic disorders listed in this document.

Causas de fallecimiento en pacientes con el virus de la inmunodeficiencia humana: ¿son diferentes en la era del tratamiento antirretroviral de gran actividad? / Evolution of causes of death in HIV patients: have they changed in the HAART era?

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