Validation of the Spanish Version of the ICECAP-O for Nursing Home Residents with Dementia

Background Measurement of health-related quality of life (HRQoL) is important for a chronic disease, such as dementia, which impairs the quality of life of affected patients in addition to their length of life. This is important in the context of economic evaluations when interventions do not (only) affect HRQoL and these other factors also affect overall quality of life. Objective To validate the Spanish translation of the ICECAP-O's capability to measure Health-related quality of life in elderly with dementia who live in nursing homes. Method Cross-sectional study. For 217 residents living in 8 Spanish nursing homes, questionnaires were completed by nursing professionals serving as proxy respondents. We analyzed the internal consistency and other psychometric properties. We investigated the convergent validity of the ICECAP-O with other HRQoL instruments, the EQ-5D extended with a cognitive dimension (EQ-5D+C), the Alzheimer's Disease Related Quality of Life (ADRQL) measures, and the Barthel Index measure of activities of daily living (ADL). Results The ICECAP-O presents satisfactory internal consistency (alpha 0.820). The factorial analysis indicated a structure of five principal dimensions that explain 66.57% of the total variance. Convergent validity between the ICECAP-O, EQ-5D+C, ADRQL, and Barthel Index scores was moderate to good (with correlations of 0.62, 0.61, and 0.68, respectively), but differed between dimensions of the instruments. Discriminant validity was confirmed by finding differences in ICECAP-O scores between subgroups based on ADL scores (0.70 low, 0.59 medium, and 0.39 high level care), dementia severity (0.72 mild, 0.63 medium, and 0.50 severe), and ages (0.59 below 75 years and 0.84 above 75 years). Conclusions This study presented the first use of a Spanish version of the ICECAP-O. The results indicate that the ICECAP-O appears to be a reliable Health-related quality of life measurement instrument showing good convergent and discriminant validity for people with dementia

Comparación psicométrica de las escalas PAINAD y Abbey Pain Scale en centros sociosanitarios de Barcelona

RESUMEN: Introducción: Se estima que el 30-50 % de las personas con demencia experimentan dolor crónico en residencias en España. A pesar de que hay validadas muchas escalas para la valoración del dolor en personas con demencia, sigue sin existir una que pueda considerarse como el gold standard. Además, no hay estudios realizados al respecto en medio sociosanitario. Por ello nos proponemos como objetivos principales la comparación psicométrica de la escala Pain Assessment in Advanced Dementia (PAINAD) y la Abbey Pain Scale (ABBEY) en personas con demencia en centros sociosanitarios. Metodología: Se llevaron a cabo un análisis de comparación psicométrica y un diseño transversal descriptivo. Se incluyeron mayores de 65 años con demencia moderada-severa ingresados en centros sociosanitarios del área sanitaria del Baix Llobregat. Resultados: El alfa de Cronbach en reposo para la escala PAINAD fue de 0,847 y durante el aseo de 0,845. Para la escala ABBEY se obtuvo un alfa de Cronbach de 0,728 en reposo y de 0,814 durante el aseo. Ambas escalas mostraron buenas concordancias, pero en el análisis por ítems los cambios físicos y los cambios fisiológicos de la ABBEY demostraron muy poca sensibilidad. La prevalencia de dolor basal ha sido del 43,9 % y durante el aseo fue del 73,5 %. Conclusiones: Ambas escalas mantuvieron buenas propiedades psicomimétricas pero la escala PAINAD es claramente mejor valorada. La prevalencia de dolor en personas con demencias ingresadas en centros sociosanitarios es del 43,9 %. Se propone para la mejor evaluación del dolor pasar la escala durante una actividad que implique movimiento.ABSTRACT: Introduction: It is estimated that 30-50 % of people with dementia experience chronic pain at nursing homes in Spain. Despite the fact that there are many validated scales for the assessment of pain in people with dementia, there is still no single scale that may be considered the goldstandard. Furthermore, no studies have been carried out in this regard in a social and health environment. Therefore, we propose as primary objective a psychometric comparison of the Pain Assessment in Advanced Dementia Scale (PAINAD) and the Abbey Pain Scale (ABBEY) in people with dementia in long-term care facilities. Methodology: To achieve the objective we simultaneously carried out a psychometric comparison analysis and a descriptive cross-sectional design. Those over 65 years of age with moderate-severe dementia admitted to social health centers in the Baix Llobregat health area were included. Results: Cronbach?s alpha at rest for the PAINAD scale was 0.847 and 0.845 during toilet. For the ABBEY scale, a Cronbach?s alpha of 0.728 was obtained at rest and of 0.814 during toilet. Both scales showed good agreements, but in the item analysis ABBEY showed very little sensitivity for physical changes and physiological changes. The prevalence of pain at baseline was 43.9 %, and during grooming it was 73.5 %. Conclusions: Both scales displayed good psychometric properties but the PAINAD scale was clearly better. The prevalence of pain in people with dementia admitted to health centers is 43.9 %. Pain in people with dementia may need to be measured during movement activity to reveal actual pain

Prevalencia de úlceras por presión en pacientes sometidos a artrodesis de columna

Objetivos: Identificar la incidencia de úlceras por presión (UPP) en el quirófano en pacientes sometidos a artrodesis de columna realizadas en el intervalo de 2 años. Material y métodos: Diseño descriptivo, trasversal retrospectivo. Revisión de historias clínicas. Resultados: Se valoraron 269 pacientes, 52% mujeres, de una media de edad de 58,7 años. Las posiciones más frecuentes fueron decúbito supino y decúbito prono (34% ambas). La prevalencia de UPP fue del 14%, con un 51,4% de grado II, y la localización más frecuente fue tórax y frente. La mayor frecuencia de aparición fue a partir de las 4 horas de intervención, pero no hallamos relaciones significativas entre la aparición de úlceras por presión y otras variables. Conclusiones: Es necesario llevar a cabo estudios de intervención para prevenir UPP en el área quirúrgica, debido a que existe poca bibliografía al respecto. Por otro lado, la alta incidencia hallada nos hace plantearnos la necesidad de aumentar las medidas preventivas por parte de enfermería

Discriminant Validity.

<p>Discriminant Validity.</p

Convergent Validity.

<p>Convergent Validity.</p

Demographic and description measurement instruments (N = 217).

<p>Demographic and description measurement instruments (N = 217).</p

Total variance explained.

<p>Total variance explained.</p

Switching TNF antagonists in patients with chronic arthritis: An observational study of 488 patients over a four-year period

The objective of this work is to analyze the survival of infliximab, etanercept and adalimumab in patients who have switched among tumor necrosis factor (TNF) antagonists for the treatment of chronic arthritis. BIOBADASER is a national registry of patients with different forms of chronic arthritis who are treated with biologics. Using this registry, we have analyzed patient switching of TNF antagonists. The cumulative discontinuation rate was calculated using the actuarial method. The log-rank test was used to compare survival curves, and Cox regression models were used to assess independent factors associated with discontinuing medication. Between February 2000 and September 2004, 4,706 patients were registered in BIOBADASER, of whom 68% had rheumatoid arthritis, 11% ankylosing spondylitis, 10% psoriatic arthritis, and 11% other forms of chronic arthritis. One- and two-year drug survival rates of the TNF antagonist were 0.83 and 0.75, respectively. There were 488 patients treated with more than one TNF antagonist. In this situation, survival of the second TNF antagonist decreased to 0.68 and 0.60 at 1 and 2 years, respectively. Survival was better in patients replacing the first TNF antagonist because of adverse events (hazard ratio (HR) for discontinuation 0.55 (95% confidence interval (CI), 0.34-0.84)), and worse in patients older than 60 years (HR 1.10 (95% CI 0.97-2.49)) or who were treated with infliximab (HR 3.22 (95% CI 2.13-4.87)). In summary, in patients who require continuous therapy and have failed to respond to a TNF antagonist, replacement with a different TNF antagonist may be of use under certain situations. This issue will deserve continuous reassessment with the arrival of new medications. © 2006 Gomez-Reino and Loreto Carmona; licensee BioMed Central Ltd