Barriers associated with poor control in Spanish diabetic patients. A consensus study.

BACKGROUND: Delphi technique allows developing a multidisciplinary consensus to establish solutions. AIM: To identify barriers and solutions to improve control in patients with Type-2 Diabetes Mellitus (DM2). METHODS: An observational study using the 2-round Delphi technique (June-August 2011). A panel of 108 experts in DM2 from medical and nursing fields (primary care providers and specialists) from different regions completed via email a questionnaire with 41 Likert statements and 9 scores for each one. Level of agreement was assessed using measures of central tendency and dispersion. We analysed commonalities/differences between the two groups (Kappa index and McNemar chi-square). RESULTS: Response rate: 65%. Degree of agreement: 63.4% (95% CI 48.7-78.1%) in medicine, and 78.1% (95% CI 65.4-90.8) in nursing (p > 0.05). Overall level of agreement: Kappa = 0.43, (χ(2) = 2.5 p > 0.05). Regarding non-compliance with therapy, it improves with: the information to the partner/family/caregiver, patient education degree in diabetes, patient motivation and ability to share and agree on decisions with the patient. Clinical inertia improves with: motivation degree of healthcare professionals and the calculation of cardiovascular risk; and gets worse with: the shortage of time in consultation, absence of data in medical record, border high limits measurements accepted as normal readings, lack of a treatment goals, lack of teamwork (Physician/Nurse), scarcity of resources and lack of alarm systems in the electronic medical record on goals to achieve. CONCLUSION: The participants achieved an agreement in interventions in non-therapeutic compliance and clinical inertia to improve DM2 control.

[Incidence of pulmonary tuberculosis: application of the capture-recapture method]. / Incidencia de tuberculosis pulmonar: aplicación del método de captura-recaptura.

OBJECTIVE: To determine as accurately as possible the incidence of pulmonary tuberculosis within Health Area 15 of the Community of Valencia during the period 1990-1993, using the capture-recapture method. METHOD: Descriptive study on the population of Health Area 15 (population: -139.903) divided into 4 large groups according to age (0-14, 15-34, 34-54 and 55+). Data was obtained from the statutory notification system of infectious disease (SNSID) and from the registry of the said area's Hospital Microbiology SERVICE: The main variable under study was the number of cases of pulmonary tuberculosis, both as notified under the SNSID and in terms of cases in the microbiology register in which M. tuberculosis was isolated. The incidence-rates were calculated by age and year of study for both registries employing the capture-recapture method. RESULTS: The mean annual incidence obtained for the SNSID register during the study period was 15.85 cases x 10(-5), and for the microbiology registry it was 23.29 x 10(-5). When the capture-recapture method was employed the mean annual incidence for the study period was 34.81 x 10(-5) (CI 95%: 31.82-39.92). In each of the years studied the number of cases identified was greater for the microbiology register than for the SNSID. Around half the cases of tuberculosis are below 34 years of age, with the larger section, and that having the highest incidence of tuberculosis being the 15 to 34 years age-group. There is no apparent upward trend in incidence rates calculated for this period. CONCLUSIONS: The data from the SNSID system on incidence of pulmonary tuberculosis within Health Area 15 of the Community of Valencia tends to underestimate the true incidence rate. The factual resources of the Hospital Microbiology Service are underutilized, considering the quantity and quality of information it can provide. The capture-recapture method is a good choice of method for measuring tuberculosis incidence. This method merits greater use within the field of epidemiology as much in order to assess the representativeness and thoroughness of surveillance systems as to identify inadequacies in their reporting and localisation of disease outbreaks.

Estatinas: eficacia, seguridad e indicaciones / Statins: useful, security and indications

Las estatinas han demostrado que son útiles en la prevención de la enfermedad cardiovascular: infarto de miocardio, ictus, mortalidad cardiovascular y total. Los beneficios del tratamiento se manifiestan sobre todo en pacientes que han padecido una enfermedad cardiovascular o con un riesgo cardiovascular alto. Las dosis mínimas eficaces de las estatinas en la prevención de la enfermedad cardiovascular son: atorvastatina 10 mg/dia, simvastatina 20-40 mg/dia, lovastatina 20-40 mg/dia y pravastatina 40 mg/dia. Estas dosis consiguen un 20% de reducción del cLDL (colesterol de las lipoproteínas de baja densidad) en los ensayos clínicos. La hepatotoxicidad y miotoxicidad son los efectos secundarios más importantes de las estatinas. La elevación de las transaminasas y la aparición de síntomas musculares son la forma de detectarlos. Las estatinas están indicadas para el tratamiento de la enfermedad cardiovascular o en un paciente con riesgo cardiovascular alto cuando el cLDL sea superior a 115 mg/dl

The statins have demonstrated that they are useful in the prevention of the cardiovascular illness: myocardial infarction, stroke, cardiovascular and total mortality. The benefits of the treatment are manifested mainly in patients that have suffered a cardiovascular illness or with a high cardiovascular risk. The effective minimum dose daily of the statins in the prevention of the cardiovascular illness is: atorvastatin 10 mg, simvastatin 20-40 mg, lovastatin 20- 40 mg and pravastatin 40 mg. These doses get 20% of reduction of the cLDL (cholesterol of the lipoproteins of low density) in the randomised clinical trials. The hepatic and muscular effects are the most important adverse events. The elevation of the AST or ALT and the appearance of muscular symptoms are the form of detecting them. The treatment with statins is suitable for patients with cardiovascular illness or with high cardiovascular risk when the cLDL is superior to 115 mg/dl