Autoperception and satisfaction with health: two medical care markers in elderly hospitalized patients. Quality of life as an outcome estimate of clinical practice.

This paper reports a prospective study, carried out in elderly patients hospitalized for acute illness, designed to evaluate the effectiveness of medical treatment from the point of view of quality of life (QoL). Patient's autoperception and satisfaction with health, the most relevant subjective estimates of QoL, were assessed on admission to hospital and at check-up after discharge. A comprehensive functional evaluation of the patients was made. The results indicated an improvement in health autoperception coherent with the professional view. However, health satisfaction was not modified in any way after medical treatment. This dissonance could be explained because the predictors of satisfaction, age, sex, functional status and comorbidity, are the factors least modified by treatment. Satisfaction with ones own health could be a crucial marker of QoL especially for chronic diseases, but not appropriate for monitoring treatment effectiveness of acute illness. Health autoperception seems to be more desirable as an outcome estimate for this purpose.

Clinicoepidemiologic characteristics, prognostic factors, and survival analysis of patients coinfected with human immunodeficiency virus and Leishmania in an area of Madrid, Spain.

From 1987 to 1995, a retrospective case study was conducted at the Ramon y Cajal Hospital in Madrid, Spain, a public teaching hospital with 1,100 beds, to determine the clinicoepidemiologic characteristics, survival, and prognostic factors of patients with visceral leishmaniasis (VL) and human immunodeficiency virus (HIV) infection. The prevalence of VL in HIV+ patients compared with HIV- patients was studied. Epidemiologic, clinical, and parasitologic characteristics, as well as the effects of treatment, prognosis, and survival in 54 HIV+ patients (90 episodes) with VL were defined. Comparative survival studies among patients with and without acquired immunodeficiency syndrome (AIDS)-defining criteria and multivariate analysis of survival risk factors were performed. The prevalence of VL in patients with AIDS was much higher than in immunocompetent individuals. In spite of a good initial response to treatment for VL, 60.6% of the patients had relapsed by the end of one year. Mortality from the first episode was 18.5%, and 24% died in the first month after diagnosis of any VL episode. The mean survival of the 29 patients who died was 10.27 months. Survival in patients with and without AIDS at the time of the first episode of VL was compared at 30 months: 53.7% versus 20.5% (P = 0.00149). We found no significant difference (P = 0.24) in the survival of HIV+ patients who had died of VL without AIDS at the time of the first episode of VL compared with those of a control group of 413 dead patients with AIDS without VL. A diagnosis of AIDS at the time of the first episode of VL and thrombocytopenia were the only risk factors found related to survival. We conclude that in AIDS patients, VL is a recurrent disease that is highly prevalent and whose clinical course is modified by HIV.

[The hypolipemic effect of concentrated salmon oil rich in n-3 fatty acids]. / Efecto hipolipemiante de un concentrado de aceite de salmón, rico en ácidos grasos n-3.

The lipid-lowering effect of a concentrated salmon oil, rich in n-3 fatty acids was tested as a supplement to the normal diet of 27 patients with high levels of cholesterol and/or triglycerides, during 2 months. The results of the study confirmed that addition of n-3 fatty acid to diets produced a reduction of plasma levels of lipids. The most significant reduction of plasma levels of lipids. The most significant reduction was observed in triglycerides in patients with high levels (from 295.8 to 219.8 mg/dl) (p = 0.001), as well as the whole group (from 231 to 180 mg/dl) (p = 0.002). At the same time, there was a reduction of cholesterol in all patients (from 295 to 268.4 mg/dl) (p = 0.001), including those whose cholesterol was higher (from 316.2 to 284.9 mg/dl) (p = 0.002). We concluded that the use of compounds rich in n-3 fatty acids showed an important plasma lipid-lowering effect, playing a significant role in hyperlipidemic patient control.

Prognostic value of gastric intramucosal pH in critically ill children.

OBJECTIVE: To determine the association of tonometrically measured gastric intramucosal pH (pHi) to the occurrence of multiple organ dysfunction syndrome (MODS) and death in critically ill children. DESIGN: Prospective, observational study. SETTING: Pediatric intensive care unit (ICU) of a teaching children's hospital. PATIENTS: Fifty-one critically ill children admitted (median age 5.4+/-5 [SD] yrs; range 1 mo to 16 yrs) with the following diagnoses: post major surgery (n=26), sepsis (n=8), multiple trauma (n=5), acute respiratory distress syndrome (n=4), and "miscellaneous" (n=8). INTERVENTIONS: Placement of a tonometric catheter. MEASUREMENTS AND MAIN RESULTS: Pediatric Risk of Mortality (PRISM) score and clinical data were collected on admission and pHi daily during their stay in the pediatric ICU. A sigmoid tonometer was used to determine the pHi. Unconditional logistic regression was used to investigate the prognostic value of pHi. On admission, 26 patients presented with low gastric pHi (< or =7.35) and 17 of them had values of <7.30. The mortality rate in children with pHi <7.30 was 47.1% (95% confidence interval, 26.2 to 69) in contrast with an 11.7% mortality rate (95% confidence interval, 4.6 to 26.6) in children having a pHi of > or =7.30 (p=.015). The pHi and PRISM score on admission were independent predictive factors of death. The risk of mortality is increased when the pHi is low (odds ratio=2.5). However, we did not find the pHi to be a predictor for developing MODS. CONCLUSIONS: Our results show that pHi is an independent predictor of mortality in patients admitted to a pediatric ICU. Although no relationship was observed between the risk of MODS and gastric pHi, the univariate difference of 21% vs. 41% is highly suggestive. The pHi determination is a minimally invasive procedure and well tolerated in children of all ages.

Evaluation of agreement among dermatologists in the assessment of the color of port wine stains and their clearance after treatment with the flashlamp-pumped dye laser.

BACKGROUND: Color classification and its subjective clearance evaluation in response to treatment are essential in the management of patients with port wine stains (PWS). But color perception by physicians is not an objective measurement so that it can change among observers. Agreement among physicians is essential for the reliability of the color classification and the clinical assessment of the response to laser treatment. OBJECTIVE: The purpose of our study was to determine the reliability of the clinical color classification of port wine stains and of their color change or clearance in response to laser treatment. The study was not designed to evaluate the outcome of laser treatment in PWS or the factors that could predict the final response. METHODS: We used the kappa index to evaluate the proportion of agreement in color and clearance perception among dermatologists. Six dermatologists classified the initial color of PWS in 80 patients. Three of them also assessed the amount of clearance achieved after treatment with the flashlamp-pumped dye laser. These three dermatologists were usually dedicated to treat patients with PWS, while the other three were not. RESULTS: The kappa index showed a substantial agreement in both cases. No difference in the initial color perception was observed between the group of dermatologists specialized in PWS and the other three dermatologists. CONCLUSION: These results favor the reliability of the clinical method in the assessment of PWS before and after laser treatment. So, although subjective, color perception by physicians can be used in the study of laser treatment outcome in PWS and its related factors, and the results of different authors can be compared.