Prioritization criteria of patients on scheduled waiting lists for abdominal wall hernia surgery: a cross-sectional study.

PURPOSE: Long delays in waiting lists have a negative impact on the principles of equity and providing timely access to care. This study aimed to assess waiting lists for abdominal wall hernia repair (incisional ventral vs. inguinal hernia) to define explicit prioritization criteria. METHODS: A cross-sectional single-center study was designed. Patients in the waiting list for incisional/ventral hernia (n = 42) and inguinal hernia (n = 50) repair were interviewed by phone and completed health-related quality of life (HRQoL) questionnaires (EQ-5D, COMI-hernia, HerQLes) as a measure of severity. Priority was measured as hernia complexity, patient frailty using the modified frailty index (mFI-11), and the consumption of analgesics for hernia. RESULTS: The mean (SD) time on the waiting list was 5.5 (3.2) months (range 1-14). Complex hernia was present in 34.8% of the patients. HRQoL was moderately poor in patients with incisional/ventral hernia (mean HerQL score 66.1), whereas it was moderately good in patients with inguinal hernia (mean COMI-hernia score 3.40). The use of analgesics was higher in patients with incisional/ventral hernia as compared with those with inguinal hernia (1.48 [0.54] vs. 1.31 [0.51], P = 0.021). Worst values of mFI were associated with inguinal hernia as compared with incisional/ventral hernia (0.21 [0.14] vs. 0.12 [0.11]; P = 0.010). CONCLUSION: Explicit criteria for prioritization in the waiting lists may be the consumption of analgesics for patients with incisional/ventral hernia and frailty for patients with inguinal hernia. A reasonable approach seems to establish separate waiting lists for incisional/ventral hernia and inguinal hernia repair.

[Movement disorders units and management of motor fluctuations in advanced Parkinson's disease]. / Unidades de trastornos del movimiento y tratamiento de las fluctuaciones motoras de la enfermedad de Parkinson avanzada.

INTRODUCTION: Advanced Parkinson's disease (PD) entails complications, such as motor fluctuations. In Spain, medical attention for such cases is often provided in movement disorder units (MDU). AIM: To gain further knowledge of the diagnostic resources and therapeutic approach of MDU. SUBJECTS AND METHODS: A descriptive cross-sectional study was conducted. The researchers designed an on-line questionnaire, addressed to neurologists from MDUs, containing 48 questions about the resources they have available, the number of patients with PD and motor fluctuations that have been attended to, as well as the therapeutic approach, according to the Hoehn and Yahr (HY) scale. RESULTS: Fifty-five neurologists participated. Structural neuroimaging is available to 100% of them; 89% have access to functional neuroimaging; 89% have acute pharmacological tests available for use; 78% have access to genetic tests; and 53% have transcranial ultrasound at their disposal. There are 2.5 neurologists and 1.2 nurses per unit. Of the patients with PD that they see, 19% of them are in HY stage 1, 59% are in HY stage 2-3 and 22% are in HY stage 4-5. Treatment consists, first of all, in monoamine oxidase type B inhibitors in HY stages 1 and 2, and levodopa in HY stages 3, 4 and 5. Twenty-four per cent of the patients have motor fluctuations, with 5.5 off episodes per day, lasting 44 minutes, with a total of seven off hours per day. Fourteen per cent of the patients under 70 years of age with more than three long-term off episodes per day are receiving invasive treatment for motor fluctuations. CONCLUSIONS: MDUs are well equipped with diagnostic and pharmacological resources. Pharmacological treatments are tailored to each patient with a wide range of combinations. Despite this optimisation, the prevalence of motor fluctuations is still high in advanced patients, and invasive therapies may be underused.

TITLE: Unidades de trastornos del movimiento y tratamiento de las fluctuaciones motoras de la enfermedad de Parkinson avanzada.Introduccion. La enfermedad de Parkinson (EP) avanzada conlleva complicaciones, como fluctuaciones motoras. Su atencion sanitaria en España se realiza frecuentemente en unidades de trastornos del movimiento (UTM). Objetivo. Conocer los recursos diagnosticos y el abordaje terapeutico de las UTM. Sujetos y metodos. Estudio descriptivo, transversal. Se diseño un cuestionario en linea, dirigido a neurologos de UTM, de 48 preguntas sobre recursos disponibles, numero de pacientes atendidos con EP y con fluctuaciones motoras, y abordaje terapeutico segun el estadio de Hoehn y Yahr (HY). Resultados. Participaron 55 neurologos. Disponen de neuroimagen estructural el 100%; neuroimagen funcional, el 89%; tests agudos farmacologicos, el 89%; tests geneticos, el 78%, y ecografia transcraneal, el 53%. Hay 2,5 neurologos y 1,2 enfermeras por unidad. Atienden a un 19% de pacientes con EP en estadio de HY 1, un 59% en estadio de HY 2-3 y un 22% en estadio de HY 4-5. Utilizan en primer lugar los inhibidores de la monoaminooxidasa B en los estadios de HY 1 y 2, y levodopa en los estadios de HY 3, 4 y 5. Un 24% de los pacientes tiene fluctuaciones motoras, con 5,5 episodios off diarios, de 44 minutos, con un total de siete horas off diarias. Un 14% de los pacientes de hasta 70 años con mas de tres episodios off diarios de larga duracion recibe tratamiento invasivo para las fluctuaciones motoras. Conclusiones. Las UTM estan bien dotadas de recursos diagnosticos y farmacologicos. Los tratamientos farmacologicos se individualizan con gran variedad de combinaciones. A pesar de esta optimizacion, la prevalencia de fluctuaciones motoras es todavia alta en pacientes avanzados, y las terapias invasivas pueden infrautilizarse.