Artroplàstia primària de genoll (2005-2012)

Artroplàstia; Genoll; HospitalitzacióArthroplasty; Knee; HospitalizationArtroplastia; Rodilla; HospitalizaciónL'artroplàstia de genoll és una cirurgia per reemplaçar, mitjançant una pròtesi, la ròtula o ambdues superfícies de l'articulació del genoll. L'objectiu de l'atles és identificar i descriure la variabilitat en les hospitalitzacions per artroplàsties de genoll

L’estimulació (convencional) de la medul·la espinal en el tractament del dolor neuropàtic refractari i el dolor isquèmic

Electroestimulació; Mèdul·la espinal; Dolor neuropàtic refractari; Dolor isquèmic crònicElectroestimulación; Médula espinal; Dolor neuropático refractario; Dolor isquémico crónicoElectrostimulation; Spinal cord; Refractory neuropathic pain; Chronic ischemic painLa finalitat d’aquest document és examinar els efectes beneficiosos i adversos de l’estimulació convencional de la medul·la espinal (EME) segons les principals indicacions avaluades (dolor neuropàtic refractari i dolor isquèmic crònic) així com el cost-efectivitat d’aquesta intervenció. Aquest informe recull l’evidència existent sobre els efectes adversos i beneficiosos de l’electroestimulació de la medul·la espinal, la relació cost-efectivitat de la intervenció, així com un examen del seu ús i indicacions actualment al sistema de salut de Catalunya per al tractament del dolor neuropàtic refractari i el dolor isquèmic

Tractament nutricional de pacients amb insuficiència cardíaca i desnutrició: revisió de l’evidència

Desnutrició; Insuficiència cardíaca; Tractament nutricional mèdicDesnutrición; Insuficiencia cardíaca; Tratamiento nutricional médicoMalnutrition; Heart failure; Medical nutritional treatmentAquest article té com a objectiu avaluar la seguretat i l’eficàcia/efectivitat del tractament nutricional (SNO i NE) en pacients amb IC i desnutrició

Effect on Health-related Quality of Life of changes in mental health in children and adolescents

<p>Abstract</p> <p>Background</p> <p>The objective of the study was to assess the effect of changes in mental health status on health-related quality of life (HRQOL) in children and adolescents aged 8 - 18 years.</p> <p>Methods</p> <p>A representative sample of Spanish children and adolescents aged 8-18 years completed the self-administered KIDSCREEN-52 questionnaire at baseline and after 3 years. Mental health status was measured using the Strengths and Difficulties Questionnaire (SDQ). Changes on SDQ scores over time were used to classify respondents in one of 3 categories (improved, stable, worsened). Data was also collected on gender, undesirable life events, and family socio-economic status. Changes in HRQOL were evaluated using effect sizes (ES). A multivariate analysis was performed to identify predictors of poor HRQOL at follow-up.</p> <p>Results</p> <p>Response rate at follow-up was 54% (n = 454). HRQOL deteriorated in all groups on most KIDSCREEN dimensions. Respondents who worsened on the SDQ showed the greatest deterioration, particularly on Psychological well-being (ES = -0.81). Factors most strongly associated with a decrease in HRQOL scores were undesirable life events and worsening SDQ score.</p> <p>Conclusions</p> <p>Changes in mental health status affect children and adolescents' HRQOL. Improvements in mental health status protect against poorer HRQOL while a worsening in mental health status is a risk factor for poorer HRQOL.</p

Avaluació del cribratge neonatal de l’atròfia muscular espinal

Atròfia muscular espinal; Cribratge neonatal; Avaluació; Detecció precoçAtrofia muscular espinal; Cribado neonatal; Evaluación; Detección precozSpinal muscular atrophy; Neonatal screening; Evaluation; Early detectionL'objectiu d'aquest informe és avaluar la inclusió de l’atròfia muscular espinal dins d’un programa de cribratge neonatal en base a l’evidència sobre la seva eficàcia, efectivitat i seguretat, així com els requisits o principis establerts per implementar cribratges genètics i programes de cribratge en general

Hacia la concentración de la cirugía oncológica digestiva: cambios en la activad, las técnicas y los resultados

Objetivo: se examinaron los cambios en actividad, técnicas quirúrgicas y resultados del proceso de concentración de la cirugía oncológica digestiva compleja entre 2005-2012 en relación a 1996-2000. Material y métodos: se realizó un estudio de cohortes retrospectivo a partir del Conjunto Mínimo Básico de Datos (CMBD) al alta hospitalaria (1996-2012) de centros públicos de Catalunya. Población > 18 años intervenida de cáncer de: esófago, páncreas, hígado, estómago y recto. Los centros se clasificaron en: bajo, medio y alto volumen (≤ 5, 6-10 y > 10 procedimientos/año, respectivamente). Utilización del test tendencia Chi-cuadrado para valorar la concentración de pacientes en centros de alto volumen y la evolución de la mortalidad hospitalaria y regresión logística para estudiar la relación entre volumen y resultado en el periodo de concentración (2005-2012). Resultados: se ha producido una progresiva concentración de la cirugía oncológica digestiva compleja, mediante la reducción de entre un 10% (hígado) y 46% (esófago) del número de hospitales que realizan estas intervenciones y el aumento significativo del porcentaje de pacientes intervenidos en centros de alto volumen (todas las p tendencia < 0,0001, excepto esófago). También se observa una reducción significativa de la mortalidad, especialmente en esófago (de 15% en 1996/2000 a 7% en 2009/12, p tendencia = 0,003) y páncreas (de 12% en 1996/2000 a 6% en 2009/2012, p tendencia < 0,0001). Conclusiones: se ha producido una concentración efectiva de la cirugía oncológica digestiva en Cataluña en centros de alto volumen que se ha acompañado de una reducción de la mortalidad hospitalaria clara en esófago y páncreas, aunque sin cambios significativos en los otros cánceres estudiados

Artroplàstia primària de maluc (2005-2012)

Artroplàstia; Maluc; HospitalitzacióArthroplasty; Hip; HospitalizationArtroplastia; Cadera; HospitalizaciónL’artroplàstia primària de maluc és un procediment quirúrgic en el qual l’articulació del maluc és substituïda per un implant protèsic. L'objectiu de l'atles és identificar i descriure la variabilitat en les hospitalitzacions per artroplàsties de maluc total i parcial

Patients report improvements in continuity of care when quality of life assessments are used routinely in oncology practice: Secondary outcomes of a randomised controlled trial.

INTRODUCTION AND AIM: In a randomised trial investigating the effects of regular use of health-related quality of life (HRQOL) in oncology practice, we previously reported an improvement in communication (objective analysis of recorded encounters) and patient well-being. The secondary aims of the trial were to measure any impact on patient satisfaction and patients' perspectives on continuity and coordination of their care. METHODS: In a prospective trial involving 28 oncologists, 286 cancer patients were randomised to: (1) intervention arm: regular touch-screen completion of HRQOL with feedback to physicians; (2) attention-control arm: completion of HRQOL without feedback; and (3) control arm: no HRQOL assessment. Secondary outcomes were patients' experience of continuity of care (Medical Care Questionnaire, MCQ) including 'Communication', 'Coordination' and 'Preferences to see usual doctor' subscales, patients' satisfaction, and patients' and physicians' evaluation of the intervention. Analysis employed mixed-effects modelling, multiple regression and descriptive statistics. RESULTS: Patients in the intervention arm rated their continuity of care as better than the control group for 'Communication' subscale (p=0.03). No significant effects were found for 'Coordination' or 'Preferences to see usual doctor'. Patients' evaluation of the intervention was positive. More patients in the intervention group rated the HRQOL assessment as useful compared to the attention-control group (86% versus 29%), and reported their doctors considered daily activities, emotions and quality of life. CONCLUSION: Regular use of HRQOL measures in oncology practice brought changes to doctor-patient communication of sufficient magnitude and importance to be reported by patients. HRQOL data may improve care through facilitating rapport and building inter-personal relationships

Differences in results and related factors between hospital-at-home modalities in Catalonia: a cross-sectional study

This is the final version. Available on open access from MDPI via the DOI in this record. Hospital-at-home (HaH) is a healthcare modality that provides active treatment by healthcare staff in the patient's home for a condition that would otherwise require hospitalization. The aims were to describe the characteristics of different types of hospital-at-home (HaH), assess their results, and examine which factors could be related to these results. A cross-sectional study based on data from all 2014 HaH contacts from Catalonia was designed. The following HaH modalities were considered-admission avoidance (n = 7,214; 75.1%) and early assisted discharge (n = 2,387; 24.9%). The main outcome indicators were readmission, mortality, and length of stay (days). Multivariable models were fitted to assess the association between explanatory factors and outcomes. Hospital admission avoidance is a scheme in which, instead of being admitted to acute care hospitals, patients are directly treated in their own homes. Early assisted discharge is a scheme in which hospital in-care patients continue their treatment at home. In the hospital avoidance modality, there were 8.3% readmissions, 0.9% mortality, and a mean length of stay (SD) of 9.6 (10.6) days. In the early assisted discharge modality, these figures were 7.9%, 0.5%, and 9.8 (11.1), respectively. In both modalities, readmission and mean length of stay were related to comorbidity and type of hospital, and mortality with age. The results of HaH in Catalonia are similar to those observed in other contexts. The factors related to these results identified might help to improve the effectiveness and efficiency of the different HaH modalities

Predictive validity of the CriSTAL tool for short-term mortality in older people presenting at Emergency Departments: a prospective study

© 2018, The Author(s). Abstract: To determine the validity of the Australian clinical prediction tool Criteria for Screening and Triaging to Appropriate aLternative care (CRISTAL) based on objective clinical criteria to accurately identify risk of death within 3 months of admission among older patients. Methods: Prospective study of ≥ 65 year-olds presenting at emergency departments in five Australian (Aus) and four Danish (DK) hospitals. Logistic regression analysis was used to model factors for death prediction; Sensitivity, specificity, area under the ROC curve and calibration with bootstrapping techniques were used to describe predictive accuracy. Results: 2493 patients, with median age 78–80 years (DK–Aus). The deceased had significantly higher mean CriSTAL with Australian mean of 8.1 (95% CI 7.7–8.6 vs. 5.8 95% CI 5.6–5.9) and Danish mean 7.1 (95% CI 6.6–7.5 vs. 5.5 95% CI 5.4–5.6). The model with Fried Frailty score was optimal for the Australian cohort but prediction with the Clinical Frailty Scale (CFS) was also good (AUROC 0.825 and 0.81, respectively). Values for the Danish cohort were AUROC 0.764 with Fried and 0.794 using CFS. The most significant independent predictors of short-term death in both cohorts were advanced malignancy, frailty, male gender and advanced age. CriSTAL’s accuracy was only modest for in-hospital death prediction in either setting. Conclusions: The modified CriSTAL tool (with CFS instead of Fried’s frailty instrument) has good discriminant power to improve prognostic certainty of short-term mortality for ED physicians in both health systems. This shows promise in enhancing clinician’s confidence in initiating earlier end-of-life discussions