Characteristics of 107 Spanish healthcare registries and evaluation of the utilization thereof

BACKGROUND: The information concerning the currently existing healthcare registries in our country is not readily accessible, is scarce and some are not well-known, possibly being underused in comparison to their many potential uses. This study is aimed at evaluating the characteristics of the Spanish Healthcare registries and the utilization thereof, especially in Healthcare technology assessment. METHODS: Descriptive, cross-sectional study of the Spanish Healthcare registries within the 1997-2002 period. These registries were identified by means ofa bibliographic databases search and by way of a survey of Scientific Societies and Central and Autonomic Healthcare Administration. Another bibliographic databases search was conducted of the publications which use data from the healthcare registries included and have been evaluated by applying the scientific evidence quality criteria. RESULTS: A total of 107 healthcare registries were identified, most of which of local or regional coverage (71%), preferably were under Autonomic government authority (64.5%). The areas showing the largest number of registries identified were those related to death statistics (16.8%) and cancer (15.9%). A total of 298 publications were retrieved which analyze data produced by the registries identified, most of which are devoted to the study of the frequency and distribution of the events recorded (58.1%) and less frequently to the conducting of healthcare technology assessment studies (24.4%). CONCLUSIONS: The critical evaluation of the publications made it possible to identify some elements related to the analysis methodology and design which would heighten the quality of the healthcare technology assessment. Healthcare registries in Spain have developed recently and to differing degrees. Important areas without any records and improvement elements related to the use of healthcare registries for healthcare technology assessment were detected. It would be advisable to avail of a register of registries which would provide relevant, up-dated information thereon. Fundamento:La información sobre los registros sanitarios exis-tentes en nuestro país es poco accesible y escasa y algunos son pococonocidos, pudiendo estar infrautilizados en relación con sus múlti-ples usos potenciales. El objetivo de este trabajo es evaluar las carac-terísticas de los Registros Sanitarios españoles y su utilización, espe-cialmente en Evaluación de Tecnologías Sanitarias.Métodos:Estudio descriptivo transversal de los Registros Sanita-rios españoles entre 1997 y 2002. La identificación de los registros serealizó a través de búsqueda bibliográfica y mediante encuesta a Socie-dades Científicas y Administración sanitaria central y autonómica. Seha realizado una búsqueda bibliográfica específica de las publicacio-nes que utilizan datos de los registros sanitarios incluidos y se han eva-luado aplicando los criterios de calidad de la evidencia científica.Resultados:Se han identificado 107 registros sanitarios, prefe-rentemente de cobertura local o regional (71%) y dependientes en sumayoría de la Administración autonómica (64,5%). Las áreas conmayor número de registros identificados corresponden a la mortali-dad (16,8%) y al cáncer (15,9%). Se han recuperado 298 publicacio-nes que analizan datos producidos por los registros identificados, delas que la mayoría se dedican al estudio de la frecuencia y distribuciónde los eventos registrados (58,1%) y con menor frecuencia a la reali-zación de estudios de evaluación de tecnologías sanitarias (24,4%).Conclusiones: La evaluación crítica de las publicaciones ha per-mitido identificar algunos elementos relacionados con el diseño y lametodología de análisis que incrementarían la calidad de los estudiosde evaluación de tecnologías sanitarias.Los registros sanitarios enEspaña han tenido un desarrollo desigual y reciente. Se han detecta-do áreas relevantes sin registros y elementos de mejora relacionadoscon la utilización de los registros sanitarios para estudios de evalua-ción de tecnologías sanitarias. Sería recomendable contar con unregistro de registros que proporcionara información relevante yactualizada sobre los mismo

Comparison of seven prognostic tools to identify low-risk pulmonary embolism in patients aged <50 years

publishersversionPeer reviewe

New-Onset Atrial Fibrillation in Sepsis: A Narrative Review

Atrial fibrillation (AF) is a frequently identified arrhythmia during the course of sepsis. The aim of this narrative review is to assess the characteristics of patients with new-onset AF related to sepsis and the risk of stroke and death, to understand if there is a need for anticoagulation. We searched for studies on AF and sepsis on PubMed, the Cochrane database, and Web of Science, and 17 studies were included. The mean incidence of new-onset AF in patients with sepsis was 20.6% (14.7% in retrospective studies and 31.6% in prospective). Risk factors for new-onset AF included advanced age, white race, male sex, obesity, history of cardiopulmonary disease, heart or respiratory failure, and higher disease severity score. In-hospital mortality was higher in patients with than in those without new-onset AF in 10 studies. In four studies the overall intensive care unit and hospital mortality rates were comparable between patients with and without new-onset AF, while three other studies did not provide mortality data. One study reported on the in-hospital incidence of stroke, which was 2.6 versus 0.69% in patients with or without new-onset AF, respectively. Seven of the studies provided follow-up data after discharge. In three studies, new-onset AF was associated with excess mortality at 28 days, 1 year, and 5 years after discharge of 34, 21, and 3% patients, respectively. In two studies, the mortality rate was comparable in patients with and without new-onset AF. Postdischarge stroke was reported in five studies, whereof two studies had no events after 30 and 90 days, one study showed a nonsignificant increase in stroke, and two studies demonstrated a significant increase in risk of stroke after new-onset AF. The absolute risk increase was 0.6 to 1.6%. Large prospective studies are needed to better understand the need for anticoagulation after new-onset AF in sepsis

Implementation of home hospitalization and early discharge as an integrated care service: a ten years pragmatic assessment

Home Hospitalization has proven efficacy, but its effectiveness and potential as an Integrated Care Service in a real world setting deserves to be explored. Objective: To evaluate implementation and 10 years follow-up of Home Hospitalization and Early Discharge as an Integrated Care Service in an urban healthcare district in Barcelona. Methods: Prospective study with pragmatic assessment. Patients: Surgical and medical acute and exacerbated chronic patients requiring admission into a highly specialized hospital, from 2006 to 2015. Intervention: Home-based individualized care plan, administered as a hospital-based outreach service, aiming at substituting hospitalization and implementing a transitional care strategy for optimal discharge. Main measurements: Emergency Department, readmissions and mortality. Patients' and professionals' perspectives, technologies and costs were evaluated. Results: 4,165 admissions (71 ± 15 yrs; Charlson Index 4 ± 3). In-hospital stay was 1 (0-3) days and the length of home-based stay was 6 (5-7) days. The 30-day readmission rate was 11% and mortality was 2%. Patients, careers and health professionals expressed high levels of satisfaction (98%). At the start, the service was reimbursed at a flat rate of 918€ per patient discharged, significantly lower than conventional hospitalization (2,879€) but still allowing the hospital to keep a balanced budget. At present, there is no difference in the payment schemes for both types of services. Conclusions: The service freed an average of 6 in-hospital days per patient. The program showed health value generation, as well as potential for synergies with community-based Integrated Care Services.The publication of the current work has been fully supported by CONNECARE (UE Grant n° 689802)

Recurrent bleeding and thrombotic events after resumption of oral anticoagulants following gastrointestinal bleeding: Communication from the ISTH SSC Subcommittee on Control of Anticoagulation

Background: Gastrointestinal bleeding frequently complicates anticoagulant therapy causing treatment discontinuation. Data to guide the decision regarding whether and when to resume anticoagulation based on the risks of thromboembolism and recurrent bleeding are scarce. Objectives: We aimed to retrospectively evaluate the incidence of these events after anticoagulant-related gastrointestinal bleeding and assess their relationship with timing of anticoagulation resumption. Methods: Patients hospitalized because of gastrointestinal bleeding during oral anticoagulation for any indication were eligible. All patients were followed up to 2 years after the index bleeding for recurrent major or clinically relevant non-major bleeding, venous or arterial thromboembolism, and mortality. Results: We included 948 patients hospitalized for gastrointestinal bleeding occurring during treatment with vitamin K antagonists (n = 531) or direct oral anticoagulants (n = 417). In time-dependent analysis, anticoagulant treatment was associated with a higher risk of recurrent clinically relevant bleeding (hazard ratio [HR] 1.55; 95% confidence interval [CI] 1.08–2.22), but lower risk of thromboembolism (HR 0.34; 95% CI 0.21–0.55), and death (HR 0.50; 95% CI 0.36–0.68). Previous bleeding, index major bleeding, and lower glomerular filtration rate were associated with a higher risk of recurrent bleeding. The incidence of recurrent bleeding increased after anticoagulation restart independently of timing of resumption. Conclusions: Anticoagulant treatment after gastrointestinal bleeding is associated with a lower risk of thromboembolism and death, but higher risk of recurrent bleeding. The latter seemed to be influenced by patient characteristics and less impacted by time of anticoagulation resumption

Genotypes Coding for Low Serum Levels of Mannose-Binding Lectin Are Underrepresented among Individuals Suffering from Noninfectious Systemic Inflammatory Response Syndrome▿

Gene polymorphisms, giving rise to low serum levels of mannose-binding lectin (MBL) or MBL-associated protease 2 (MASP2), have been associated with an increased risk of infections. The objective of this study was to assess the outcome of intensive care unit (ICU) patients with systemic inflammatory response syndrome (SIRS) regarding the existence of functionally relevant MBL2 and MASP2 gene polymorphisms. The study included 243 ICU patients with SIRS admitted to our hospital, as well as 104 healthy control subjects. MBL2 and MASP2 single nucleotide polymorphisms were genotyped using a sequence-based typing technique. No differences were observed regarding the frequencies of low-MBL genotypes (O/O and XA/O) and MASP2 polymorphisms between patients with SIRS and healthy controls. Interestingly, ICU patients with a noninfectious SIRS had a lower frequency for low-MBL genotypes and a higher frequency for high-MBL genotypes (A/A and A/XA) than either ICU patients with an infectious SIRS or healthy controls. The existence of low- or /high-MBL genotypes or a MASP2 polymorphism had no impact on the mortality rates of the included patients. The presence of high-MBL-producing genotypes in patients with a noninfectious insult is a risk factor for SIRS and ICU admission

The Spatio-temporal exploration of health and housing tenure transitions using the Northern Ireland Longitudinal Study

Functional Enrichment Analyses of lists of genes included in the expression patterns found along the progressive stages of 3 diseases: MDS, AD, CRC. (A) Functional enrichment on terms from Gene Ontology Biological Process (GO-BP) for the 24 genes included in MDS pattern 1. (B) Functional enrichment on GO-BP terms for the 39 genes included in AD pattern 4; (C) Functional enrichment on GO-BP terms for the 168 genes included in CRC patterns 2, 3 and 4. (XLSX 15 kb

Additional file 1: Table S1. of Identification of expression patterns in the progression of disease stages by integration of transcriptomic data

Significant genes found in the patterns associated to the progression of MDS: A total set of 189 genes were found. These genes are included in one of the 4 patterns identified (marked in red colors in the case of the 2 increasing trends or green colors in the case of the 2 decreasing trends). The Gamma correlation factor and the adjusted p-value of such correlation are included for each gene in its pattern. (XLSX 79 kb

Additional file 2: Table S2. of Identification of expression patterns in the progression of disease stages by integration of transcriptomic data

Significant genes found in the patterns associated to the progression of AD: In total 74 genes were found as significant assigned to one of the 4 AD patterns. The patterns are marked in red colors in the case of increasing trends or green colors in the case of decreasing trends. The Gamma correlation factor and the adjusted p-value of such correlation are included for each gene in its pattern. (XLSX 13 kb