How do implant patients experience complications? A cross-sectional multicentre pilot study.

BACKGROUND: This cross-sectional study aimed to quantify the impact of implant-related complications on perceived pain, functional impairment, concern, quality of life (QoL) and confidence which were the study's primary outcomes. MATERIALS AND METHODS: Patients were recruited in five centres over 19 months. They completed a structured ad hoc questionnaire scoring pain, chewing ability, concern, QoL and confidence in future implant treatment. Some potential independent variables were also recorded. The data were analysed descriptively and with a multiple-stepwise regression model for correlations of the five primary variables with the other data. RESULTS: The sample consisted of 408 patients, with prosthesis mobility being the most common complication (40.7%). Most patients (79.2%) consulted because of a complication, while 20.8% were asymptomatic and consulted regularly. Pain was correlated with symptoms at consultation and in biological/mixed complications (p < .001; R2 = 44.8%). Chewing impairment with implant loss, prosthesis fracture and removable implant-supported or total prostheses (p < .001; R2 = 42.8%); patient concern was correlated with the clinical symptoms and removable implant-supported prostheses (p < .001; R2 = 36.1%); impact on QoL was correlated with implant loss, prosthesis fracture and removable implant-supported prostheses (p < .001; R2 = 41.1%). Patient confidence was relatively independent and only impact on quality of life significantly influenced it (r = 0.73). CONCLUSIONS: Implant-related complications moderately impaired patients' perceptions of pain, chewing ability, concern and QoL. Nevertheless, complications only slightly reduced their confidence in future implant treatment.

[Primary care for diabetic patients: a quality improvement cycle]. / Evaluación de la calidad en cuidados médicos prestados a pacientes diabéticos: un ciclo de mejora.

OBJECTIVE: The aim of this study was to evaluate and improve the quality of medical care provided to diabetic patients following the standards proposed by the American Diabetes Association. MATERIAL AND METHODS: The study was conducted in three phases by analyzing data from the computerized clinical history of a sample of 340 patients. First phase (2010): cross-sectional, descriptive study which assessed the proportion of patients who met the standards related to the screening of diabetes, and goals of control and treatment. Subsequently, health professionals reviewed the results in order to promote the implementation of corrective action. Finally (2012), a new assessment with the same standards was performed. RESULTS: An increase in the number of patients treated with insulin (12.7% in 2010 and 20.2% in 2012) was observed (P < .01). There were also percentage increases in the number of patients who met the screening standards as regards analytical determinations: glycosylated hemoglobin (from 44.4% to 68.2%), lipid profile (47.6%-73.8%), creatinine (32.5% - 73.5%), and albumin-creatinine ratio (9.2%-24.4%) (P < .001). Only 6.4% (CI: 3.2- 9.8) of diabetic patients attained the composite target of glycosylated hemoglobin < 7%, blood pressure < 130/80 mmHg and low-density lipoprotein cholesterol < 100 mg/dl in 2012. CONCLUSIONS: This study shows that medical care has improved the goals related to analytical determinations and the number of insulin-treated diabetic type 2 patients. An optimal level was also maintained in metabolic control of diabetes, but there was still poor control of risk factors for cardiovascular disease.

Evaluación de la calidad en cuidados médicos prestados a pacientes diabéticos: un ciclo de mejora / Primary care for diabetic patients: A quality improvement cycle

Objetivo: Evaluar y mejorar la calidad de los cuidados médicos prestados a pacientes diabéticos a través de los estándares propuestos por la Asociación Americana de Diabetes. Material y métodos: El estudio se realizó en 3 fases, sobre una población diana de 2.795 pacientes diabéticos, analizando los registros en la historia clínica informatizada de una muestra de 340 individuos. Primera fase (año 2010): estudio transversal, descriptivo, donde se evaluó el cumplimiento de estándares relacionados con el cribado, metas de control y tratamiento de la diabetes. En la segunda realizamos una intervención basada en sesiones grupales sobre los profesionales sanitarios. Finalmente evaluamos el cumplimiento de los mismos estándares, durante la asistencia prestada en 2012. Resultados: El porcentaje de diabéticos tipo 2 tratados con insulina se incrementó desde el 12,7% en 2010 al 20,2% en 2012 (p < 0,01). También aumentó el porcentaje de pacientes en los que se cumplió el cribado relacionado con determinaciones analíticas: hemoglobina glucosilada (del 44,4% al 68,2%), perfil lipídico (del 47,6% al 73,8%), creatinina (del 32,5% al 73,5%) y cociente albúmina-creatinina (del 9,2% al 24,4%) (p < 0,001). El 4,2% (IC: 0,9%-7,1%) de los diabéticos alcanzaron, a la vez, las metas recomendadas de hemoglobina glucosilada, tensión arterial y lipoproteínas de baja densidad en 2010, mientras que en el año 2012 fueron el 6,4% (IC: 3,2%-9,8%). Conclusiones: Mejoramos el cribado de parámetros analíticos, insulinizamos más a los pacientes con diabetes tipo 2, pero conseguimos un pobre control de enfermedades, asociadas a la diabetes, que suponen importantes factores de riesgo cardiovascular (AU)

Objective: The aim of this study was to evaluate and improve the quality of medical care provided to diabetic patients following the standards proposed by the American Diabetes Association. Material and methods. The study was conducted in three phases by analyzing data from the computerized clinical history of a sample of 340 patients. First phase (2010): cross-sectional, descriptive study which assessed the proportion of patients who met the standards related to the screening of diabetes, and goals of control and treatment. Subsequently, health professionals reviewed the results in order to promote the implementation of corrective action. Finally (2012), a new assessment with the same standards was performed. Results: An increase in the number of patients treated with insulin (12.7% in 2010 and 20.2% in 2012) was observed (P < .01). There were also percentage increases in the number of patients who met the screening standards as regards analytical determinations: glycosylated hemoglobin (from 44.4% to 68.2%), lipid profile (47.6%-73.8%), creatinine (32.5% - 73.5%), and albumin-creatinine ratio (9.2%-24.4%) (P < .001). Only 6.4% (CI: 3.2- 9.8) of diabetic patients attained the composite target of glycosylated hemoglobin < 7%, blood pressure < 130/80 mm Hg and low-density lipoprotein cholesterol < 100 mg/dl in 2012. Conclusions: This study shows that medical care has improved the goals related to analytical determinations and the number of insulin-treated diabetic type 2 patients. An optimal level was also maintained in metabolic control of diabetes, but there was still poor control of risk factors for cardiovascular disease (AU)