Development of a predictive model of hospitalization in primary care patients with heart failure

Background Heart failure (HF) is the leading cause of hospitalization in people over age 65. Predictive hospital admission models have been developed to help reduce the number of these patients. Aim To develop and internally validate a model to predict hospital admission in one-year for any non-programmed cause in heart failure patients receiving primary care treatment. Design and setting Cohort study, prospective. Patients treated in family medicine clinics. Methods Logistic regression analysis was used to estimate the association between the predictors and the outcome, i.e. unplanned hospitalization over a 12-month period. The predictive model was built in several steps. The initial examination included a set of 31 predictors. Bootstrapping was used for internal validation. Results The study included 251 patients, 64 (25.5%) of whom were admitted to hospital for some unplanned cause over the 12 months following their date of inclusion in the study. Four predictive variables of hospitalization were identified: NYHA class III-IV, OR (95% CI) 2.46 (1.23–4.91); diabetes OR (95% CI) 1.94 (1.05–3.58); COPD OR (95% CI) 3.17 (1.45–6.94); MLHFQ Emotional OR (95% CI) 1.07 (1.02–1.12). AUC 0.723; R2N 0.17; Hosmer-Lemeshow 0.815. Internal validation AUC 0.706.; R2N 0.134 Conclusion This is a simple model to predict hospitalization over a 12-month period based on four variables: NYHA functional class, diabetes, COPD and the emotional dimension of the MLHFQ scale. It has an acceptable discriminative capacity enabling the identification of patients at risk of hospitalization.This study was financed by the Health Research Fund (FIS), grant no. PI 14/01677 and co-financed with ERDF funds from the European Union: REDISSEC - Project ISCIII (Red de Investigación en Enfermedades Crónicas del Servicio de Salud - Instituto de Salud Carlos III) concession no. RD16/0001/0004. The Foundation for Biosanitary Research and Innovation in Primary Health Care (FIIBAP) financed the costs of publishing the articl

Effectiveness of Mindfulness-based interventions to improve control of type 2 diabetes mellitus: A systematic review and preliminary meta-analytic integration

El propósito de este trabajo fue estudiar la efectividad de intervenciones basadas en Mindfulness sobre el nivel de hemoglobina glicada —HbA1c— en pacientes con diabetes mellitus tipo 2 —DM2—. Se realizó una revisión sistemática e integración metanalítica preliminar. La búsqueda de los estudios se realizó en las siguientes bases: PubMed, Bireme, Web of Science, SciELO, Embase, EBSCOhost, SCOPUS, Psychology Database. Se identificaron 10 artículos: cuatro fueron llevados a cabo en Estados Unidos, dos en Irán, uno en Alemania, uno en Australia, uno en Tailandia y uno en Inglaterra. Se observó una reducción en los niveles de la HbA1c utilizando Mindfulness en comparación a los grupos controles (p < 0,02). Además, se observó un efecto diferenciado al analizar según número de participantes, sexo y tiempo de seguimiento. Se concluyó que el uso de intervenciones basadas en Mindfulness tendría un efecto indirecto sobre la reducción de la hemoglobina glicadaThe purpose of this paper was to study the effectiveness of Mindfulness-based interventions on the level of glycated hemoglobin —HbA1c— in patients with type 2 diabetes mellitus —DM2—. A systematic review and preliminary meta-analytic integration was performed. The search of the studies was carried out in the following bases: PubMed, Bireme, Web of Science, SciELO, Embase, EBSCOhost, SCOPUS, Psychology Database. Ten articles were identified: four were published in the United States, two in Iran, one in Germany, one in Australia, one in Thailand and one in England. A reduction in HbA1c levels was observed using Mindfulness compared to control groups (p <0,02). In addition, according to the number of participants, sex and time of follow-up a differentiated effect was found. It was concluded that the use of interventions based on Mindfulness would have an indirect effect on the reduction of glycated hemoglobin (HbA1c

Effectiveness of a strategy that uses educational games to implement clinical practice guidelines among Spanish residents of family and community medicine (e-EDUCAGUIA project):A clinical trial by clusters

This study was funded by the Fondo de Investigaciones Sanitarias FIS Grant Number PI11/0477 ISCIII.-REDISSEC Proyecto RD12/0001/0012 AND FEDER Funding.Background: Clinical practice guidelines (CPGs) have been developed with the aim of helping health professionals, patients, and caregivers make decisions about their health care, using the best available evidence. In many cases, incorporation of these recommendations into clinical practice also implies a need for changes in routine clinical practice. Using educational games as a strategy for implementing recommendations among health professionals has been demonstrated to be effective in some studies; however, evidence is still scarce. The primary objective of this study is to assess the effectiveness of a teaching strategy for the implementation of CPGs using educational games (e-learning EDUCAGUIA) to improve knowledge and skills related to clinical decision-making by residents in family medicine. The primary objective will be evaluated at 1 and 6months after the intervention. The secondary objectives are to identify barriers and facilitators for the use of guidelines by residents of family medicine and to describe the educational strategies used by Spanish teaching units of family and community medicine to encourage implementation of CPGs. Methods/design: We propose a multicenter clinical trial with randomized allocation by clusters of family and community medicine teaching units in Spain. The sample size will be 394 residents (197 in each group), with the teaching units as the randomization unit and the residents comprising the analysis unit. For the intervention, both groups will receive an initial 1-h session on clinical practice guideline use and the usual dissemination strategy by e-mail. The intervention group (e-learning EDUCAGUIA) strategy will consist of educational games with hypothetical clinical scenarios in a virtual environment. The primary outcome will be the score obtained by the residents on evaluation questionnaires for each clinical practice guideline. Other included variables will be the sociodemographic and training variables of the residents and the teaching unit characteristics. The statistical analysis will consist of a descriptive analysis of variables and a baseline comparison of both groups. For the primary outcome analysis, an average score comparison of hypothetical scenario questionnaires between the EDUCAGUIA intervention group and the control group will be performed at 1 and 6months post-intervention, using 95% confidence intervals. A linear multilevel regression will be used to adjust the model. Discussion: The identification of effective teaching strategies will facilitate the incorporation of available knowledge into clinical practice that could eventually improve patient outcomes. The inclusion of information technologies as teaching tools permits greater learning autonomy and allows deeper instructor participation in the monitoring and supervision of residents. The long-term impact of this strategy is unknown; however, because it is aimed at professionals undergoing training and it addresses prevalent health problems, a small effect can be of great relevance. Trial registration: ClinicalTrials.gov: NCT02210442.Publisher PDFPeer reviewe

PhDAY 2020 -FOO (Facultad de Óptica y Optometría)

Por cuarto año consecutivo los doctorandos de la Facultad de Óptica y Optometría de la Universidad Complutense de Madrid cuentan con un congreso propio organizado por y para ellos, el 4º PhDAY- FOO. Se trata de un congreso gratuito abierto en la que estos jóvenes científicos podrán presentar sus investigaciones al resto de sus compañeros predoctorales y a toda la comunidad universitaria que quiera disfrutar de este evento. Apunta en tu agenda: el 15 de octubre de 2020. En esta ocasión será un Congreso On-line para evitar que la incertidumbre asociada a la pandemia Covid-19 pudiera condicionar su celebración

Estudio de la hospitalización evitable por condiciones sensibles a los cuidados ambulatorios (ACSC) y de sus factores condicionantes en la Comunidad de Madrid

Tesis doctoral inédita leida en la Universidad Autónoma de Madrid. Facultad de Medicina. Departamento de Medicina. Departamento de Medicina Preventiva y Salud Pública. Fecha de lectura: Septiembre de 200

Calidad de vida de los pacientes con dolor crónico y criterios de fragilidad en Atención Primaria.

La fragilidad es una situación clínica en la que se ve incrementada la vulnerabilidad de una persona para desarrollar discapacidad y/o mortalidad ante un estresor. Es una situación frecuente en mayores que, como el dolor crónico, tiene consecuencias como limitación de la actividad física, depresión e impacto sobre la calidad de vida. La fragilidad puede ser prevenida y tratada mediante el fomento de la actividad física. Objetivos: La presente investigación consta de dos fases: una primera fase observacional cuyo objetivo es analizar a una población mayor de 65 años con dolor crónico y observar su nivel de fragilidad, actividad, características del dolor y calidad de vida; y una segunda fase de intervención cuyo objetivo es analizar la eficacia de una intervención basada en el fomento de la actividad física para mayores identificados como prefrágiles en la primera fase de la investigación. Metodología: La identificación de los pacientes se realizará a través de la historia clínica informatizada del Servicio Madrileño de Salud, tras la identificación de pacientes prefrágiles, estos serán aleatorizados en un grupo control, que recibirá la atención habitual, y un grupo intervención al que se incluirá en un programa de actividad física basado en la ejercitación de diferentes zonas corporales, ejercicios de equilibrio y automasaje. Tras la intervención, y a los 6 meses se medirá en los dos grupos los resultados en nivel de fragilidad, actividad, calidad de vida, depresión e intensidad y localización del dolor

Calidad de vida de los pacientes con dolor crónico y criterios de fragilidad en Atención Primaria.

Frailty is a clinical state in which there is an increase in an individual’s vulnerability for developing increased dependen-cy or mortality when exposed to a stressor. It is a common state in older adults and it has consequences in: physical activity limitation, depression and poor quality of life. Theses consequences are common to chronic pain consequences. Frailty can be prevented and managed by physical activity encouragement. Objectives: This investigation is divided into two phases: the first phase of the investigation is a cross-sectional study whose objective is to analyze a population of older adults with chronic pain to determine their frailty statement and pain characteristics. The second phase of the in-vestigation consists on a randomized controlled trial whose objective is to study the effectiveness of a physical exercise program for pre-frail older adults. Methods: Participants in the first phase of the investigation will be recruited by the consultation of the electronic registers of the Madrid Health Service. After the identification of pre-frail patients, they will be randomized into a control group and an intervention group. Control group will receive ordinary recommendations for physical activity, and intervention group participants will be included in a physical exercise program for 8 weeks. After the intervention, and after 6 months follow-up, frailty statement, physical activity, quality of life, depression and intensity and location of pain will be assessed in both groups.La fragilidad es una situación clínica en la que se ve incrementada la vulnerabilidad de una persona para desarrollar discapacidad y/o mortalidad ante un estresor. Es una situación frecuente en mayores que, como el dolor crónico, tiene consecuencias como limitación de la actividad física, depresión e impacto sobre la calidad de vida. La fragilidad puede ser prevenida y tratada mediante el fomento de la actividad física. Objetivos: La presente investigación consta de dos fases: una primera fase observacional cuyo objetivo es analizar a una población mayor de 65 años con dolor crónico y observar su nivel de fragilidad, actividad, características del dolor y calidad de vida; y una segunda fase de intervención cuyo objetivo es analizar la eficacia de una intervención basada en el fomento de la actividad física para mayores identificados como prefrágiles en la primera fase de la investigación. Metodología: La identificación de los pacientes se realizará a través de la historia clínica informatizada del Servicio Madrileño de Salud, tras la identificación de pacientes prefrágiles, estos serán aleatorizados en un grupo control, que recibirá la atención habitual, y un grupo intervención al que se incluirá en un programa de actividad física basado en la ejercitación de diferentes zonas corporales, ejercicios de equilibrio y automasaje. Tras la intervención, y a los 6 meses se medirá en los dos grupos los resultados en nivel de fragilidad, actividad, calidad de vida, depresión e intensidad y localización del dolor