A randomized clinical trial of home telemonitoring in patients with advanced heart and lung diseases.

BRIEF SUMMARY: The addition of home monitoring to an integrated care model in patients with advanced chronic heart/lung diseases decreases mortality, hospital and emergency admissions, improves functional status, HRQoL, and is cost-effective. BACKGROUND: Telemonitoring is a promising implement for medicine, but its efficacy is unknown in patients with advanced heart and lung failure (AHLF). OBJECTIVE: To determine the efficacy of a telemonitoring system added to coordinated clinical care in patients with AHLF. DESIGN: Randomized phase 3 multicenter clinical trial with parallel groups in adult patients. PARTICIPANTS: Five spanish centers including patients with AHLF at discharge or in out-patient clinics. INTERVENTION: Patients were randomly assigned to receive a remote bio-parameters telemonitoring system (TELECARE) or best usual care (UCARE). TELECARE patients were provided with devices that collected symptoms and bio-parameters, and transferred them synchronously to a call-center, with a real-time health-care response. MAIN MEASURES: Primary end point was the need of admissions/emergency room visits at 45, 90, 180 days. Secondary end points included health care requirements, mortality, functional assessment, health related quality of life (HRQoL), perceived satisfaction, and cost-efficacy. RESULTS: 510 patients were included (54.5% women, median age 76.5 years; 63.1% suffered heart failure, 13.9% lung failure, and 22.9% both conditions). Clinical and functional features were comparable in both arms. TELECARE globally needed less admissions with respect UCARE after 45 days of inclusion (35.4% vs. 46.9%, p < 0.05). This tendency was maintained in the subgroups of patients with multimorbidity (34.2% vs. 46.9%, p < 0.05), intermediate risk of mortality (36.5% vs. 51.1%, p < 0.05), and those included after hospital discharge (34.9% vs. 50.5%, p < 0.01). HRQoL significantly improved (TELECARE/UCARE EuroQol baseline of 56.2 ± 18.2/55.1 ± 19.7, p = 0.054, and 64 ± 19.9/56.3 ± 21.6; p < 0.01 at the end), and perceived satisfaction was also higher (6.77 ± 0.52 vs. 6.62 ± 0.81, p < 0.001; highest possible score = 7). A trend to mortality decrease was also observed (12.9% vs. 19.3%, p = 0.13). TELECARE was cost-efficacious (TELECARE/UCARE QALY 3.94 Euros/0.81Euros). CONCLUSIONS: The addition of a telemonitoring system to an integrated care model in patients with AHLF decreases hospital and emergency admissions, improves functional status as well as HRQoL, and is cost-efficacious.

Satisfacción de los usuarios con el servicio de teleoftalmología con cámara no midriática para el cribado de la retinopatía diabética / User satisfaction with teleophthalmology with nonmydriatic camera for diabetic retinopathy screening

ObjetivoConocer la satisfacción de los pacientes diabéticos respecto al servicio de retinografía.MétodosEncuesta telefónica a 64 usuarios entre julio de 2006 y marzo de 2007. El 57,8% eran varones. La edad media fue de 65,2 años. El 54,7% procedían de un equipo de atención primaria (EAP) urbano. Las variables fueron: sexo, edad, EAP, retinografía/tonometría (normal/patológica), accesibilidad, puntualidad, limpieza, tiempo dedicado, explicaciones, buenas manos, amabilidad en escala mala/regular/buena/muy buena/perfecta, y satisfacción telefónica/global en escala 0–10.ResultadosSe valoró (>80%) la accesibilidad, la puntualidad, la limpieza, el tiempo dedicado, las buenas manos y la amabilidad. La media de satisfacción global fue de 8,38 (intervalo de confianza del 95% [IC95%]: 8,03–8,72) y la telefónica fue de 7,88 (IC95%: 7,4–8,36). Se asociaron (p<0,05) con una satisfacción global (⩾8) el tiempo de visita, las explicaciones comprensibles y la llamada telefónica que informa del resultado. La regresión logística muestra (p<0,05) que en la satisfacción influye más recibir el resultado de las exploraciones por teléfono.ConclusionesEl servicio de retinografía está bien valorado. Los resultados telefónicos son los que más influyen en la elevada satisfacción. Se impulsarán las nuevas tecnologías (SMS, e-mail)(AU)

ObjectiveTo determine satisfaction with the retinography service among patients with diabetes.MethodsWe performed a telephone survey of 64 users from July 2006 to March 2007. The mean age was 65.2 years, 57.8% were men, and 54.7% were from urban primary care centers. The variables analyzed were sex, age, primary care team, retinography/tonometry (normal/pathologic), accessibility, punctuality, hygiene, consultation length, explanations, good hands, kindness on a scale rated bad/average/good/very good/perfect, satisfaction with the telephone call informing users of the results of the examination, and overall satisfaction, both rated on a scale from 0 to 10.ResultsAccessibility, punctuality, hygiene, consultation length, good hands and kindness received scores of >80%. The mean overall satisfaction score was 8.38% (95% confidence interval [95%CI]: 8.03–8.72), while satisfaction with the telephone call was 7.88% (95%CI: 7.4–8.36). The variables associated (p<0.05) with overall satisfaction of ⩾8 were consultation length, receiving comprehensible explanations, and the telephone call informing patients of the results of the examination. Logistic regression showed (p<0.05) that the variable with the greatest influence on satisfaction was the telephone call.Conclusionsthe retinography service was favorably evaluated. The variable with the greatest influence on high satisfaction was communicating the results by telephone. The service will promote new technologies (SMS, e-mail)(AU)

[User satisfaction with teleophthalmology with nonmydriatic camera for diabetic retinopathy screening]. / Satisfacción de los usuarios con el servicio de teleoftalmología con cámara no midriática para el cribado de la retinopatía diabética.

OBJECTIVE: To determine satisfaction with the retinography service among patients with diabetes. METHODS: We performed a telephone survey of 64 users from July 2006 to March 2007. The mean age was 65.2 years, 57.8% were men, and 54.7% were from urban primary care centers. The variables analyzed were sex, age, primary care team, retinography/tonometry (normal/pathologic), accessibility, punctuality, hygiene, consultation length, explanations, good hands, kindness on a scale rated bad/average/good/very good/perfect, satisfaction with the telephone call informing users of the results of the examination, and overall satisfaction, both rated on a scale from 0 to 10. RESULTS: Accessibility, punctuality, hygiene, consultation length, good hands and kindness received scores of >80%. The mean overall satisfaction score was 8.38% (95% confidence interval [95%CI]: 8.03-8.72), while satisfaction with the telephone call was 7.88% (95%CI: 7.4-8.36). The variables associated (p<0.05) with overall satisfaction of 8 were consultation length, receiving comprehensible explanations, and the telephone call informing patients of the results of the examination. Logistic regression showed (p<0.05) that the variable with the greatest influence on satisfaction was the telephone call. CONCLUSIONS: the retinography service was favorably evaluated. The variable with the greatest influence on high satisfaction was communicating the results by telephone. The service will promote new technologies (SMS, e-mail).

Avances en vacunas contra la malaria / Advances in vaccines against malaria

Los últimos avances en el desarrollo de una vacuna contra la malaria van encaminados a conseguir que ésta sea a la vez segura e inmunógena. Actualmente existen diversos tipos de vacunas en estudio, dirigidas hacia las distintas fases del ciclo vital del Plasmodium. De esta manera se han desarrollado vacunas que actúan en la fase asexual (pre y eritrocítica) y en la fase sexual (bloqueo de la transmisión) del parásito. Hemos revisado los últimos datos obtenidos sobre estas líneas de investigación y las dificultades que se presentan para la obtención de una vacuna eficaz

The last advances in the development against malaria vaccines are going to get a safe and immunogenic vaccines. At the moment there are several types of vaccines in investigation, they are directed at the different phases of the vital cycle of Plasmodium. So vaccines have been developed to actuating in the asexual phase (pre and erytrocytic vaccines) and in the sexual phase (transmission block vaccines) parasite. We have reviewed the last studies and the problems to achieve an efficient vaccine

[Prevalence of depression in patients over 65 years of age. Profile of the elderly at risk]. / Prevalencia de depresión en mayores de 65 años. Perfil del anciano de riesgo.

OBJECTIVES: To calculate the prevalence of emotional disorders in primary care, using a screening test--the Yesavage--and the association of emotional disorders with other variables, with the aim of identifying the profile of an elderly person most likely to be depressed at some juncture of his/her life. DESIGN: Cross-sectional, descriptive study. SETTING: Urban health care. PATIENTS AND OTHER PARTICIPANTS: Sample of 173 patients over 64 years old. MEASUREMENTS AND RESULTS: An integrated geriatric assessment was conducted. The complete version of the Yesavage scale was used (30 items). 16% prevalence of depression (score over 15) was established. The following variables were associated with depression in a statistically significant way: feminine sex (p = 0.000009), age > or = 75 (p = 0.04), illiteracy or completion of only primary education (p = 0.01), dependence in one or more activities of daily life according to the Katz index (p = 0.0000006), personal history of depression (p = 0.01), current treatment for depression (p = 0.0002), daily consumption of three or more drugs (p = 0.0009) and social isolation (p = 0.00006). Multivariate analysis revealed that low educational level (p = 0.006), dependence in one or more activities of daily life (p = 0.008) and social isolation (p = 0.0008) are the variables most associated with depression. CONCLUSIONS: The association between low educational level and depression may be due to difficulty in understanding certain questions. A therapeutic intervention into established undiagnosed depressions took place. The Yesavage geriatric scale was useful in primary care for identifying undetected cases of emotional disorder.

Prevalencia de depresión en mayores de 65 años. Perfil del anciano de riesgo / Prevalence of depression in the over-65s. Profile of the elderly person at risk

Objetivo. Estimar la prevalencia de los trastornos del ánimo en atención primaria, utilizando un test de cribado -Yesavage- y la asociación de los trastornos del ánimo a otras variables, para buscar el perfil del anciano que es más probable que presente una depresión a lo largo de su vida. Diseño. Estudio descriptivo, transversal. Emplazamiento. ABS urbana. Pacientes u otros participantes. Muestra de 173 pacientes mayores de 64 años. Mediciones y resultados. Se realizó una valoración geriátrica integral. Se utilizó la escala de Yesavage en su versión completa (30 ítems). La prevalencia de depresión establecida (puntuación superior a 15) fue de un 16 por ciento. Se asociaban de forma estadísticamente significativa las siguientes variables: sexo femenino (p = 0,000009), edad 75 años (p = 0,04), analfabetismo o estudios primarios (p = 0,01), dependencia para una o más de las actividades de la vida diaria (AVD) según el índice de Katz (p = 0,0000006), antecedentes personales de depresión (p = 0,01), tratamiento actual antidepresivo (p = 0,0002), toma diaria de 3 o más fármacos (p = 0,0009) y aislamiento social (p = 0,00006). Según el análisis multivariante, el nivel de estudios bajo (p = 0,006), la dependencia para una o más de las AVD (p = 0,008) y el aislamiento social (p = 0,0008) son las variables que se asocian con una mayor prevalencia de depresión. Conclusiones. Es posible que la asociación entre nivel de estudios bajo y depresión se deba a la dificultad de entendimiento de ciertas preguntas. Se realizó intervención terapéutica sobre depresiones establecidas no diagnosticadas. La escala geriátrica de Yesavage resulta útil en atención primaria para identificar casos de trastorno de ánimo no detectados (AU)