Variability in the frequency of rheumatology consultations in patients with rheumatoid arthritis in Spain.

The aim of this work was to assess the variability in the use of health-care resources, based on the number of visits to rheumatology departments by rheumatoid arthritis patients, in Spain, and its association with patient, physician and center characteristics. The sample consisted of patient records of men and women (aged 16 or older), with a clinical diagnosis of RA, who met the American Rheumatism Association 1987 revised criteria and who had been treated in a rheumatology department at a Spanish hospital with at least one visit to a rheumatologist during the two years preceding the date of the study. To analyze which variables were independently associated with the number of consultations, those with a statistically significant result in the bivariate analysis, or which were clinically relevant or deemed confounders, were used in the construction of a linear regression model. The records of 1188 RA patients were studied. The linear regression model explained the 26.67 % of the variability in the number of visits. The number of csDMARDs prescribed, the administration of biological therapy, corticoid prescription, the presence of nursing consultation, mean time to first visit in the department and attended population showed a positive significant association, while the presence of telephone consultation, distance from the hospital to the patient´s residence (≥20 km) and drug monitoring by rheumatology department + primary care physician or by other specialists were negatively associated with the number of consultations. We observed a high variability in the number of visits, which remains partially unexplained even after taking into account individual, physician and center characteristics.

Bias in clinical epidemiological study designs

Systematic error, or bias, is error that occurs in each measurement made and which has a direction, i.e., the measured value is always either greater or smaller than the true value. The presence of systematic error directly affects the internal validity of the study, and indirectly affects the external validity of the results obtained. In general, such error can be classified as selection bias, classification bias or confounding bias. It is essential to deal with possible bias in the research design phase, since only confounding bias can be controlled in the phase corresponding to analysis of the results(AU)

Bias in clinical epidemiological study designs.

Systematic error, or bias, is error that occurs in each measurement made and which has a direction, i.e., the measured value is always either greater or smaller than the true value. The presence of systematic error directly affects the internal validity of the study, and indirectly affects the external validity of the results obtained. In general, such error can be classified as selection bias, classification bias or confounding bias. It is essential to deal with possible bias in the research design phase, since only confounding bias can be controlled in the phase corresponding to analysis of the results.

Incidencia de efectos adversos en un hospital de tercer nivel / No disponible

OBJETIVO: Medir la incidencia y características de los EfectosAdversos (EA) registrados en un hospital de tercer nivel. MÉTODOS: Cohorte retrospectiva de pacientes ingresados en Cirugía General, Medicina Interna y UCI, por ser donde se presenta mayor frecuencia y/o magnitud de EA. A partir de una estimación de EA del 20%, la muestra fue de 349. Se identificó el EA a partir de una hoja de cribado y se confirmó con el MRF2. RESULTADOS: Se revisaron 365 historias. Se cribaron 31,2% de pacientes con posible EA y se confirmaron 16,2% como verdaderos positivos. El total de EA fue 77, en el 82,4% existen evidencias de evitación. Los de mayor magnitud: infección nosocomial, 4,1% y reacción adversa medicamentosa, 3,5%. CONCLUSIONES: El porcentaje de EA presente en el hospital es alto, así como el grado de evitación de muchos de ellos; se deberían implantar procedimientos que permitan disminuir los EA más incidentes

OBJECTIVE: To messure the incidence and characteristics of the adverse effects (AE) registered in the Virgen de las Nieves University Hospital in Granada, Spain METHODS: Retrospective cohort of patients in General Surgery, Internal Medicine and Critical Care departments, given the higher fequency and importance of AE registered. For an estimation of 20% of AE, the sample was 349. AE were identified from screening questionnaire and were confirmed with the MRF2 questionnaire. RESULTS: Were inspected 365 clinical history. 31.2% patients with possible AE were found and were confirmed 16.2%. The total AE number was 77. In 82.4% of the cases evidence of trying to avoid the AE was found. More frequently; nosocomial infections, 4.1% and medication produced reactions, 3.5%.CONCLUSIONS: The percentage of EA present in the hospital is high and and avoidability is high in most of the cases. Should take this into account to try to decrease the number of the most incident AE

Seguimiento de indicadores de calidad de la prescripción tras infarto agudo de miocardio / Monitoring of quality indicators of prescriptions after acute myocardial infarction

Objetivos. La enfermedad cardiovascular constituye la principal causa de muerte en todo el mundo. Diferentes fármacos han mostrado su eficacia en el manejo de los pacientes con síndrome coronario agudo, incorporándose a las recomendaciones establecidas por diferentes sociedades científicas. El objetivo de este estudio es valorar el seguimiento de los estándares de calidad establecidos en Andalucía para el manejo de pacientes con infarto agudo de miocardio con elevación del segmento ST y analizar la fuente de variabilidad que aporta el facultativo prescriptor. Método. Estudio observacional, descriptivo, de indicación-prescripción, que analizó todas las prescripciones incluidas en los informes de alta hospitalaria de pacientes atendidos en un hospital de tercer nivel tras sufrir infarto agudo de miocardio con elevación del segmento ST, entre agosto de 2005 y julio de 2007. Resultados. El total de pacientes incluidos fue 287. La prescripción de antiagregantes se realizó en 99,3% de los pacientes, ácido acetilsalicílico en 95,8%. El porcentaje que recibió betabloqueantes fue 89,5%, inhibidores de la enzima de conversión de la angiotensina (IECA) 74,2%, indicándose ARA-II en 2,85%. El uso de estatinas fue de 84,6%. La indicación de nitroglicerina sublingual condicional fue 60,3%. El uso de IECA y nitroglicerina sublingual mostró diferencias estadísticamente significativas según el facultativo prescriptor. Conclusiones. La adecuación de las prescripciones a las recomendaciones establecidas en Andalucía es alta. La prescripción de nitroglicerina sublingual condicional es el indicador que más se desvía de los estándares de calidad marcados. Su uso, junto con la indicación de IECA, son las recomendaciones que presentan mayor desviación en función del facultativo prescriptor(AU)

Objectives. Cardiovascular disease is the primary cause of death in the world. Various drugs have shown their efficiency in the management of patients with acute coronary syndrome, along with the recommendations established by different Scientific Societies. The objective of this survey is to assess the monitoring of the quality standards established in Andalusia for the management of patients with myocardial infarction with evaluation of the ST segment and to analyse the source of variability of the prescription provided by the physician. Method. An observational descriptive survey, of indication-prescription, which analysed all the prescriptions included in the hospital discharge reports in patients treated in a tertiary hospital after having suffered acute myocardial infarction with ST segment elevation, between August 2005 and July 2007. Results. A total of 287 patients were included. Antiplatelets were prescribed in 99.3% of the patients, and acetylsalicylic acid in 95.8%. The percentage of beta-blockers received was 89.5%, angiotensin converting enzyme inhibitors (ACEI) in 74.2%, with ARA-II indicated in 2.85%. The use of statins was 84.6%. The indication of conditional sublingual nitroglycerin was 60.3%. The use of ACEI and sublingual nitroglycerin showed statistically significant differences according to the prescribing physician. Conclusions. The fitness of the prescriptions to the recommendations established in Andalusia is high. The prescription of conditional sublingual nitroglycerin is the indicator which varies most in the quality standards established. Its use in conjunction with the indication of ACEI, are the recommendations which show a higher deviation depending on the prescribing physician(AU)

[Monitoring of quality indicators of prescriptions after acute myocardial infarction]. / Seguimiento de indicadores de calidad de la prescripción tras infarto agudo de miocardio.

OBJECTIVES: Cardiovascular disease is the primary cause of death in the world. Various drugs have shown their efficiency in the management of patients with acute coronary syndrome, along with the recommendations established by different Scientific Societies. The objective of this survey is to assess the monitoring of the quality standards established in Andalusia for the management of patients with myocardial infarction with evaluation of the ST segment and to analyse the source of variability of the prescription provided by the physician. METHOD: An observational descriptive survey, of indication-prescription, which analysed all the prescriptions included in the hospital discharge reports in patients treated in a tertiary hospital after having suffered acute myocardial infarction with ST segment elevation, between August 2005 and July 2007. RESULTS: A total of 287 patients were included. Antiplatelets were prescribed in 99.3% of the patients, and acetylsalicylic acid in 95.8%. The percentage of beta-blockers received was 89.5%, angiotensin converting enzyme inhibitors (ACEI) in 74.2%, with ARA-II indicated in 2.85%. The use of statins was 84.6%. The indication of conditional sublingual nitroglycerin was 60.3%. The use of ACEI and sublingual nitroglycerin showed statistically significant differences according to the prescribing physician. CONCLUSIONS: The fitness of the prescriptions to the recommendations established in Andalusia is high. The prescription of conditional sublingual nitroglycerin is the indicator which varies most in the quality standards established. Its use in conjunction with the indication of ACEI, are the recommendations which show a higher deviation depending on the prescribing physician.

Survival analysis and Cox regression

The data provided by clinical trials are often expressed in terms of survival. The analysis of survival comprises a series of statistical analytical techniques in which the measurements analysed represent the time elapsed between a given exposure and the outcome of a certain event. Despite the name of these techniques, the outcome in question does not necessarily have to be either survival or death, and may be healing versus no healing, relief versus pain, complication versus no complication, relapse versus no relapse, etc.The present article describes the analysis of survival from both a descriptive perspective, based on the Kaplan–Meier estimation method, and in terms of bivariate comparisons using the log-rank statistic. Likewise, a description is provided of the Cox regression models for the study of risk factors or covariables associated to the probability of survival. These models are defined in both simple and multiple forms, and a description is provided of how they are calculated and how the postulates for application are checked – accompanied by illustrating examples with the shareware application R(AU)

Survival analysis and Cox regression.

The data provided by clinical trials are often expressed in terms of survival. The analysis of survival comprises a series of statistical analytical techniques in which the measurements analysed represent the time elapsed between a given exposure and the outcome of a certain event. Despite the name of these techniques, the outcome in question does not necessarily have to be either survival or death, and may be healing versus no healing, relief versus pain, complication versus no complication, relapse versus no relapse, etc. The present article describes the analysis of survival from both a descriptive perspective, based on the Kaplan-Meier estimation method, and in terms of bivariate comparisons using the log-rank statistic. Likewise, a description is provided of the Cox regression models for the study of risk factors or covariables associated to the probability of survival. These models are defined in both simple and multiple forms, and a description is provided of how they are calculated and how the postulates for application are checked - accompanied by illustrating examples with the shareware application R.

Conocimiento y actuación de los padres sobre la fiebre / Knowledge and management of fever by parents

Objetivos: evaluar los conocimientos y actitudes que tienen los padres sobre la fiebre, así como la influencia de los aspectos familiares. Material y métodos: cuestionario distribuido a padres de dos áreas asistenciales con hijos de 1-5 años. Para variables cualitativas se aplicaron pruebas de asociación mediante el test X2; para las variables cuantitativas se aplicó la diferencia de medias mediante la t de Student o análisis de la varianza (ANOVA). Se consideró como valor estadísticamente significativo p < 0,05. Resultados: se analizaron 288 cuestionarios. El 50% de los encuestados tiene dos hijos. Trabaja el 64,5%. En el área urbana son de mayor edad y nivel de estudios (p < 0,001). Un 50,3% considera la fiebre mala, menos los de edad media superior (p < 0,05). El 67,7% utiliza termómetro electrónico. Consideran fiebre una temperatura de 37,7 ºC en axila. Ante la fiebre, el 58,3% utiliza en primer lugar un antitérmico. El 98,2% usa medidas físicas y el 49,3% de ellos piensa que mejoran la fiebre; las usan menos los que trabajan (p < 0,05). Los de estudios superiores quitan ropa y dan líquidos más que los de estudios primarios (p = 0,035). Los antitérmicos más empleados fueron paracetamol e ibuprofeno. Un 64,6% de los encuestados percibe diferencias en cuanto a eficacia. El 85,4% utiliza la dosis indicada por su pediatra y el 21,5%, la que indica la ficha técnica, sobre todo los de estudios superiores frente a los de estudios primarios (p < 0,05). El 67,4% alterna antitérmicos, siempre aconsejados por el pediatra. Conclusiones: globalmente, en la población estudiada existe un buen conocimiento y una actitud adecuada ante la fiebre (AU)

Objective: To assess parental knowledge and attitudes about fever and the influence of social and family aspects. Methods: Questionnaires distributed to parents of children 1-5 years old in two health districts. For qualitative variables association tests with X2 test were applied, and mean differences by Student’s t-distribution or analysis of variance (ANOVA) were used for quantitative variables. It was considered statistically significant the value of p < 0.05. Results: There were 288 questionnaires analyzed. Fifty percent of respondents have 2 children, and 64.5% work. Older age and higher education levels were found in urban areas (p < 0.001). Fever was considered to be a bad thing by 50.3%, less so those with higher mean age (p < 0.05). Electronic thermometers was used in 67.7%, and 86.2% took armpit temperature considering 37.7 ºC as fever. When faced with fever, 58.3% of parents first use antipyretics. Physical measures are used in the first term by 98.2% and 49.3% think these measures lower the fever; they are used less by those parents who work (p < 0.05). Parents with higher education levels remove the clothing and give liquids more than those with primary education (p = 0.035). Most commonly used antipyretics are acetaminophen and ibuprofen; 64.6% perceived differences in efficiency; 65.4% think that ibuprofen is more effective than acetaminophen. Most parents use the dosage prescribed by the pediatrician (85.4%), and 21.5% use the dosage specified in the leaflet, especially those with higher education levels, compared to parents with primary education (p < 0.05). They sometimes alternate antipyretics (67.4%), always following the advice of their pediatrician. Conclusions: There is an overall good knowledge and attitudes about fever (AU)

Statistical inference: Hypothesis testing

The aim of statistical inference is to predict the parameters of a population, based on a sample of data.Inferential statistics encompasses the estimation of parameters and model predictions.The present article describes the hypothesis tests or statistical significance tests most commonly used in healthcare research

No disponible

Statistical inference: hypothesis testing.

The aim of statistical inference is to predict the parameters of a population, based on a sample of data. Inferential statistics encompasses the estimation of parameters and model predictions. The present article describes the hypothesis tests or statistical significance tests most commonly used in healthcare research.

Grado de adherencia al tratamiento antirretroviral para el virus de la inmunodeficiencia humana / Grade of adherence to the antiretroviral treatment for the human immunodefi ciency virus

Objetivo: Determinar el grado de adherencia de los pacientes externos del hospital al tratamiento antirretroviral para el virus de la inmunodeficiencia humana (VIH), así como los factores que puedan influir en dicha adherencia. Método: Estudio observacional transversal, realizado en los pacientes externos en tratamiento antirretroviral para el VIH que acudieron al Servicio de Farmacia del Hospital Carlos Haya de Málaga entre julio de 2006 y mayo de 2007 a retirar su medicación. Para evaluar la adherencia, se utilizó el cuestionario SMAQ (Simplified Medication Adherence Questionnaire) y se recogieron algunas variables sociodemográficas y algunos factores que podrían influir en la adherencia. Resultados: Se realizaron 72 entrevistas. El índice de participación fue del 58%; el 76% de ellos eran varones y el 53% tenían edades comprendidas entre los 36 y los 42 años. Entre los resultados obtenidos, cabe destacar que un 37% tenían estudios primarios, un 51% no seguían tratamientos concomitantes, un 47% de la población mostraba una gran preocupación por su problema de salud y un 69% tomaba correctamente el tratamiento. Conclusiones: El 54% de los pacientes no mostraron adherencia al tratamiento. Los varones presentaron una mayor adherencia que las mujeres, así como los pacientes con tratamientos concomitantes y los que seguían una buena forma de administración. Cuanto mayor era la preocupación del paciente por su problema de salud, mayor adherencia mostraba (AU)

Objective: To determine the degree of adherence of external patients on human immunodeficiency virus (HIV) antiretroviral treatment, as well as which factors could influence the adherence. Method: An observational cross sectional study was performed on external patients on HIV antiretroviral treatment who went to the Carlos Haya Hospital (Málaga) chemist service between July 2006 and May 2007 to withdraw their medication. The SMAQ questionnaire was used to assess the adherence, and some socio- demographic questions and factors that could influence the adherence. Results: 72 interviews were conducted, with a participation index of 58%, of which 76% were male, and 53% were between 36 and 42 years old. It is noteworthy that 37% have primary education, 51% have no concomitant treatment, 47% have deep concerns about their health problems, and 69% take their treatment correctly. Conclusions: 54% of the patients were not adherent to the treatment. Men were more adherent than women, as well as those who had concomitant treatments and those who had a good administration. The more preoccupied they were by their health problems, the more adherence they presented (AU)

Correlation of asymptomatic hyperuricaemia and serum uric acid levels with arterial stiffness in women with systemic lupus erythematosus without clinically evident atherosclerotic cardiovascular disease.

The objective of this article was to evaluate whether serum uric acid (SUA) correlates with arterial stiffness and inflammation markers in a cohort of women with systemic lupus erythematosus (SLE) without overt atherosclerotic cardiovascular diseases, who attended a community hospital. One hundred and two women with SLE were assessed as part of this cross-sectional study. Carotid-femoral pulse wave velocity (PWV) was measured using an automatic device (Complior). C-reactive protein (CRP), fibrinogen and homocysteine levels as well as other metabolic results were recorded. Duration and activity of SLE, damage accrual and treatments were recorded. SLE women were categorized as having or not having hyperuricaemia (HU) according to SUA levels (greater than or up to 6.2 mg/dl, respectively). A multiple linear regression analysis was used to determine the independent link between SUA levels and other variables. Women with SLE and HU (n = 15, 15%) had a worse cardiovascular risk profile that included ageing, hypertension, obesity, higher total cholesterol levels, renal failure and presence of metabolic syndrome. Also, the duration of SLE was increased and damage accrual was greater. In the unadjusted analysis, SUA levels correlated with PWV, CRP, fibrinogen and homocysteine. However, in a multivariate linear regression analysis, SUA levels independently correlated with the duration of SLE, creatinine, total cholesterol and homocysteine levels but did not correlate with PWV. In conclusion, SUA was associated with arterial stiffness, but not independently of age and homocysteine levels. Nevertheless, SUA might be an ancillary indicator of subclinical atherosclerosis in SLE women without clinically evident atherosclerotic cardiovascular disease.

Descriptive statistics.

Statistics is a science that provides precise techniques for collecting and sorting information made easy by tools and methods for further analysis. The object of descriptive statistics, from sample data, is to describe the most important characteristics, by which we refer to those amounts that provide information on the topic of interest which we are studying.

Descriptive statistics

Statistics is a science that provides precise techniques for collecting and sorting information made easy by tools and methods for further analysis.The object of descriptive statistics, from sample data, is to describe the most important characteristics, by which we refer to those amounts that provide information on the topic of interest which we are studying(AU)

[Use of the propensity score methodology in health care research]. / Uso de la metodología propensity score en la investigación sanitaria.

Observational studies are frequently used in biomedical research to determine associations between a treatment or exposure and the effects they can produce. Randomized control trials have been developed with the same purpose. Although they provide more precise results, they are more complex and costly. The use of propensity score methodology in observational studies helps to decrease the appearance of bias that they normally present, making them more accurate and with better reliability than randomized control trials. Given the increase in the use of the propensity score methodology in clinical research in recent years, we consider that it is of particular interest to make a description of it, highlighting its application scope and different use techniques.

Uso de la metodología propensity score en la investigación sanitaria / Use of the propensity score methodology in health care research

En la investigación biomédica es frecuente el diseño de estudios observacionales para determinar la asociación entre un tratamiento o exposición y el efecto que pueden producir. Con el mismo fin se desarrollan los estudios aleatorizados, que aunque obtienen resultados más precisos, son más complejos y costosos. La aplicación de la metodología propensity score (PS) en los estudios observacionales hace que disminuya la aparición de los sesgos que normalmente presentan, acercándolos en precisión y fiabilidad a los estudios aleatorizados. Dado el incremento que se ha producido en los últimos años respecto a la utilización de metodología PS en investigación clínica, consideramos que es de especial interés realizar una descripción de la misma, resaltando su ámbito de aplicación y las diferentes técnicas de uso (AU)

Observational studies are frequently used in biomedical research to determine associations between a treatment or exposure and the effects they can produce. Randomized control trials have been developed with the same purpose. Although they provide more precise results, they are more complex and costly. The use of propensity score methodology in observational studies helps to decrease the appearance of bias that they normally present, making them more accurate and with better reliability than randomized control trials. Given the increase in the use of the propensity score methodology in clinical research in recent years, we consider that it is of particular interest to make a description of it, highlighting its application scope and different use techniques (AU)