Perception of quality of care of patients with potentially severe diseases evaluated at a distinct quick diagnostic delivery model: a cross-sectional study

Background: Although hospital-based outpatient quick diagnosis units (QDU) are an increasingly recognized cost-effective alternative to hospitalization for the diagnosis of potentially serious diseases, patient perception of their quality of care has not been evaluated well enough. This cross-sectional study analyzed the perceived quality of care of a QDU of a public third-level university hospital in Barcelona. Methods: One hundred sixty-two consecutive patients aged ≥ 18 years attending the QDU over a 9-month period were invited to participate. A validated questionnaire distributed by the QDU attending physician and completed at the end of the first and last QDU visit evaluated perceived quality of care using six subscales. Results: Response rate was 98%. Perceived care in all subscales was high. Waiting times were rated as 'short'/'very short' or 'better'/'much better' than expected by 69-89% of respondents and physical environment as 'better'/'much better' than expected by 94-96 %. As to accessibility, only 3% reported not finding the Unit easily and 7% said that frequent travels to hospital for visits and investigations were uncomfortable. Perception of patient-physician encounter was high, with 90-94% choosing the positive extreme ends of the clinical information and personal interaction subscales items. Mean score of willingness to recommend the Unit using an analogue scale where 0 was 'never' and 10 'without a doubt' was 9.5 (0.70). On multivariate linear regression, age >65 years was an independent predictor of clinical information, personal interaction, and recommendation, while age 18-44 years was associated with lower scores in these subscales. No schooling predicted higher clinical information and recommendation scores, while university education had remarkable negative influence on them. Having ≥4 QDU visits was associated with lower time to diagnosis and recommendation scores and malignancy was a negative predictor of time to diagnosis, clinical information, and recommendation. Discussion: It is worthy of note that the questionnaire evaluated patient perception and opinions of healthcare quality including recommendation rather than simply satisfaction. It has been argued that perception of quality of care is a more valuable approach than satisfaction. In addition to embracing an affective dimension, satisfaction appears more dependent on patient expectations than is perception of quality. Conclusions: While appreciating that completing the questionnaire immediately after the visit and its distribution by the QDU physician may have affected the results, scores of perceived quality of care including recommendation were high. There were, however, significant differences in several subscales associated with age, education, number of QDU visits, and diagnosis of malignant vs. benign condition

Longitudinal brain atrophy and CSF biomarkers in early-onset Alzheimer's disease

There is evidence longitudinal atrophy in posterior brain areas in early-onset Alzheimer's disease (EOAD; aged < 65 years), but no studies have been conducted in an EOAD cohort with fluid biomarkers characterization. We used 3T-MRI and Freesurfer 6.0 to investigate cortical and subcortical gray matter loss at two years in 12 EOAD patients (A + T + N + ) compared to 19 controls (A-T-N-) from the Hospital Clínic Barcelona cohort. We explored group differences in atrophy patterns and we correlated atrophy and baseline CSF-biomarkers levels in EOAD. We replicated the correlation analyses in 14 EOAD (A + T + N + ) and 55 late-onset AD (LOAD; aged ? 75 years; A + T + N + ) participants from the Alzheimer's disease Neuroimaging Initiative. We found that EOAD longitudinal atrophy spread with a posterior-to-anterior gradient and beyond hippocampus/amygdala. In EOAD, higher initial CSF NfL levels correlated with higher ventricular volumes at baseline. On the other hand, higher initial CSF A?42 levels (within pathological range) predicted higher rates of cortical loss in EOAD. In EOAD and LOAD subjects, higher CSF t-tau values at baseline predicted higher rates of subcortical atrophy. CSF p-tau did not show any significant correlation. In conclusion, posterior cortices, hippocampus and amygdala capture EOAD atrophy from early stages. CSF A?42 might predict cortical thinning and t-tau/NfL subcortical atrophy.Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved

Beyond group classification: Probabilistic differential diagnosis of frontotemporal dementia and Alzheimer's disease with MRI and CSF biomarkers

Neuroimaging and fluid biomarkers are used to differentiate frontotemporal dementia (FTD) from Alzheimer's disease (AD). We implemented a machine learning algorithm that provides individual probabilistic scores based on magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) data. We investigated whether combining MRI and CSF levels could improve the diagnosis confidence. 215 AD patients, 103 FTD patients, and 173 healthy controls (CTR) were studied. With MRI data, we obtained an accuracy of 82 % for AD vs. FTD. A total of 74 % of FTD and 73 % of AD participants have a high probability of accurate diagnosis. Adding CSF-NfL and 14-3-3 levels improved the accuracy and the number of patients in the confidence group for differentiating FTD from AD. We obtain individual diagnostic probabilities with high precision to address the problem of confidence in the diagnosis. We suggest when MRI, CSF, or the combination are necessary to improve the FTD and AD diagnosis. This algorithm holds promise towards clinical applications as support to clinical findings or in settings with limited access to expert diagnoses

Influencia de la reserva cognitiva en la estructura y funcionalidad cerebral en el envejecimiento sano y patológico

[spa] INTRODUCCIÓN: El envejecimiento es un factor de riesgo para enfermedades neurodegenerativas como la Enfermedad de Alzheimer (EA), que constituye la demencia más frecuente. Uno de los objetivos de la comunidad científica, actualmente, es el diagnóstico precoz de la EA en fases previas de la demencia, es decir, detectar muy tempranamente el daño cerebral que inicialmente se manifiesta como un síndrome de la memoria y que con el tiempo evolucionará a un síndrome de demencia. Esta tesis se centrado en la EA y su fase prodrómica que se manifiesta como el síndrome denominado Deterioro Cognitivo Leve (DCL), y especialmente, en el estudio de las características cerebrales que confieren a determinadas personas una resistencia a la manifestación del daño cerebral asociado al envejecimiento o a los estadios iniciales de la demencia, ya que es un área de máximo interés en investigación en neurociencia, ya que si se consiguen comprender los mecanismos específicos, podrán mejorarse las estrategias dirigidas a paliar el impacto del deterioro cognitivo en la edad avanzada. METODOLOGÍA: La presente tesis consiste en cuatro estudios, prospectivos transversales, que examinan cómo las bases neuroanatómicas y neurofuncionales de la RC modulan tanto la estructura cómo la función cerebral en envejecimiento sano y patológico. Para la realización de los estudios se ha utilizado una muestra y diversas aproximaciones neuropsicológicas y de resonancia magnética estructural y funcional. OBJETIVO: Investigar los correlatos neuroanatómicos y neurofuncionales de la reserva cognitiva o cerebral en CTR, DCL-a y EA. RESULTADOS:En el envejecimiento sano, los sujetos con altos índices de RC, volumétricamente, muestran una mayor preservación de la integridad de la SB. Funcionalmente, se observa utilización de menos recursos cerebrales durante el procesamiento de tareas cognitivas de comprensión lingüística y percepción visual compleja.En la patología, altos índices de RC comportan una mayor atrofia cerebral y daño en la sustancia blanca. Funcionalmente, correlacionan positivamente con la intensidad de activaciones y negativamente con las desactivaciones del ‘patrón de activación por reposo’ o ‘default mode network’ (DMN) durante el procesamiento cognitivo. Altos índices de RC permite a los pacientes con DCL-a el uso de redes cerebrales alternativas.CONCLUSIONES: Los estudios descritos en esta tesis aportan evidencia de que el nivel de implicación a lo largo de la vida en actividades de tipo mental o intelectual, social y físico modula la estructura y función del cerebro. En definitiva, el concepto de RC permite explicar la resistencia y compensación que muestran algunos cerebros a manifestar clínicamente un proceso patológico subyacente

Perception of quality of care of patients with potentially severe diseases evaluated at a distinct quick diagnostic delivery model: a cross-sectional study

Background: Although hospital-based outpatient quick diagnosis units (QDU) are an increasingly recognized cost-effective alternative to hospitalization for the diagnosis of potentially serious diseases, patient perception of their quality of care has not been evaluated well enough. This cross-sectional study analyzed the perceived quality of care of a QDU of a public third-level university hospital in Barcelona. Methods: One hundred sixty-two consecutive patients aged ≥ 18 years attending the QDU over a 9-month period were invited to participate. A validated questionnaire distributed by the QDU attending physician and completed at the end of the first and last QDU visit evaluated perceived quality of care using six subscales. Results: Response rate was 98%. Perceived care in all subscales was high. Waiting times were rated as 'short'/'very short' or 'better'/'much better' than expected by 69-89% of respondents and physical environment as 'better'/'much better' than expected by 94-96 %. As to accessibility, only 3% reported not finding the Unit easily and 7% said that frequent travels to hospital for visits and investigations were uncomfortable. Perception of patient-physician encounter was high, with 90-94% choosing the positive extreme ends of the clinical information and personal interaction subscales items. Mean score of willingness to recommend the Unit using an analogue scale where 0 was 'never' and 10 'without a doubt' was 9.5 (0.70). On multivariate linear regression, age >65 years was an independent predictor of clinical information, personal interaction, and recommendation, while age 18-44 years was associated with lower scores in these subscales. No schooling predicted higher clinical information and recommendation scores, while university education had remarkable negative influence on them. Having ≥4 QDU visits was associated with lower time to diagnosis and recommendation scores and malignancy was a negative predictor of time to diagnosis, clinical information, and recommendation. Discussion: It is worthy of note that the questionnaire evaluated patient perception and opinions of healthcare quality including recommendation rather than simply satisfaction. It has been argued that perception of quality of care is a more valuable approach than satisfaction. In addition to embracing an affective dimension, satisfaction appears more dependent on patient expectations than is perception of quality. Conclusions: While appreciating that completing the questionnaire immediately after the visit and its distribution by the QDU physician may have affected the results, scores of perceived quality of care including recommendation were high. There were, however, significant differences in several subscales associated with age, education, number of QDU visits, and diagnosis of malignant vs. benign condition

Additional file 1: of Perception of quality of care of patients with potentially severe diseases evaluated at a distinct quick diagnostic delivery model: a cross-sectional study

Questionnaire Form. Validated satisfaction questionnaire of patients evaluated in the quick diagnosis unit. (DOCX 28 kb

Consumption of peanut products improves memory and stress response in healthy adults from the ARISTOTLE study: A 6-month randomized controlled trial

Background: Peanuts are rich in bioactive compounds that may have a positive impact on memory and stress response. Objective: To evaluate the effect of regular consumption of peanut products on cognitive functions and stress response in healthy young adults. Design: A three-arm parallel-group randomized controlled trial was conducted in 63 healthy young adults that consumed 25 g/day of skin roasted peanuts (SRP, n = 21), 32 g/d of peanut butter (PB, n = 23) or 32 g/d of a control butter made from peanut oil (free of phenolic compounds and fiber) (CB, n = 19) for six months. Polyphenol intake, cognitive functions, and anxiety and depression scores were evaluated using validated tests. Fecal short-chain fatty acids (SCFAs) and plasma and fecal fatty acids were assessed by chromatographic methods. Urinary cortisol was quantified by an enzymatic method. Results: Comparing the two interventions with the control, a significant reduction in anxiety scores was observed in the SRP compared to the CB group. After the intervention, consumers of SRP and PB had an improved immediate memory (p = 0.046 and p = 0.011). Lower anxiety scores were associated with SRP and PB (p < 0.001 and p = 0.002, respectively) and lower depression scores with SRP, PB and CB (p = 0.007, p = 0.003 and p = 0.032, respectively). Memory functions and stress response were significantly correlated with polyphenol intake, fecal SCFAs, plasma and fecal very long chain saturated fatty acids (VLCSFAs). Conclusions: Regular peanut and peanut butter consumption may enhance memory function and stress response in a healthy young population. These effects seem to be associated with the intake of peanut polyphenols, increased levels of fecal SCFAs, and unexpectedly, VLCSFAs, which were also present in the control product. Keywords: Cognition; Gut-brain axis; Polyphenols; Resveratrol; Short-chain fatty acids; Very long-chain saturated fatty acids