Análisis de la relación volumen-resultado en la cirugía de cáncer digestivo

Cáncer digestivo; Mortalidad intrahospitalaria; Estancia hospitalariaDigestive cancer; Inpatient mortality; Hospital stayCàncer digestiu; Mortalitat intrahospitalària; Estada hospitalàriaL’objectiu general de l’anàlisi és conèixer el número d’intervencions anuals de càncer oncològic digestiu recomanable per centre que afavoreixi els resultats en salut (mortalitat intrahospitalària i reintervencions) i d’eficiència (estada hospitalària) per als pacients intervinguts en el període 2013-2016 als centres que formen part del Sistema Nacional de Salut (SNS).The general objective of this report is to know the number of recommended annual interventions of digestive cancer by center that favor health outcomes (inpatient mortality and reinterventions) and efficiency (hospital stay) for patients who underwent cancer surgery in the period 2013-2016 in the centres belonging to the National Health System (SNS in Spanish).El objeto general del análisis es conocer el número de intervenciones anuales de cáncer oncológico digestivo recomendable por centro que favorezcan los resultados en salud (mortalidad intrahospitalaria y reintervenciones) y de eficiencia (estancia hospitalaria) para los pacientes intervenidos en el periodo 2013-2016 en los centros pertenecientes al Sistema Nacional de Salud (SNS)

A meta-analysis of smokefree legislation effects on respiratory diseases

Introduction Aim: To synthesize the available evidence in scientific papers of smokefree legislations (SFL) effects on respiratory diseases (such as asthma, chronic obstructive pulmonary disease [COPD]) and lung infections (pneumoniae, bronchitis) among all populations (adults, children or general population). Methods Systematic review and meta-analysis were carried out. PRISMA guidelines were followed. A search between January 1995 and February 2015 was performed in PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, and Google Scholar databases. The inclusion criteria were: 1)Original scientific studies concerning SFL, 2) With data before and after its implementation and 3) assessment of the impact of SFL on respiratory diseases. A meta-analysis was performed using the Review Manager (RevMan, version 5.3). The effect of SFL was estimated by risk ratios (RR) and risk difference (RD). Pooled effect measures were computed applying the inverse-variance method in a random-effect model. Heterogeneity was quantified with the I2 statistic. Subgroup and sensitivity analysis were performed. Results 17 studies reported effects on asthma, 9 on COPD and 4 on lung infections admissions. All the meta-analysis concerned comprehensive SFL settings. Six studies were included in a meta-analysis for asthma admissions in general population, 5 in children and 7 in adults. There was a significant decrease of 13% after SFL in general population (RR 0.87; 95%CI 0.81, 0.93; I2 78%) and of 15% both in children (95%CI 0.79, 0.91; I2 87%) and adults (95%CI 0.73, 0.99; I2 65%). In contrast, the 6 studies for COPD admissions showed a non significant decrease of 20% after SFL (95%CI 0.63, 1.00; I2 96%). For lung infections admissions, only 2 studies showed a non significant decrease of 14% after SFL (95%CI 0.67, 1.10; I2 55%). Conclusions SFL appears to decrease rates of admissions for asthma in all populations in comprehensive settings but not for COPD or lung infections. Funding This work was supported by the Instituto de Salud Carlos III (Institute of Health Carlos III, ISCiii) of the Ministry of Economy and Competitiveness (Spain) through the Network for Prevention and Health Promotion in Primary Care (redIAPP, RD12/0005/0001; RD16/0007/0001), co-financed with European Union ERDF funds

Prolonged Sitting Time : Barriers, Facilitators and Views on Change among Primary Healthcare Patients Who Are Overweight or Moderately Obese

Background and Objectives: Prolonged sitting time has negative consequences on health, although the population is not well aware of these harmful effects. We explored opinions expressed by primary care patients diagnosed as overweight or moderately obese concerning their time spent sitting, willingness to change, and barriers, facilitators, goals and expectations related to limiting this behaviour. Methods: A descriptive-interpretive qualitative study was carried out at three healthcare centres in Barcelona, Spain, and included 23 patients with overweight or moderate obesity, aged 25 to 65 years, who reported sitting for at least 6 hours a day. Exclusion criteria were inability to sit down or stand up from a chair without help and language barriers that precluded interview participation. Ten in-depth, semi-structured interviews (5 group, 5 individual) were audio recorded from January to July 2012 and transcribed. The interview script included questions about time spent sitting, willingness to change, barriers and facilitators, and the prospect of assistance from primary healthcare professionals. An analysis of thematic content was made using ATLAS.Ti and triangulation of analysts. Results: The most frequent sedentary activities were computer use, watching television, and motorized journeys. There was a lack of awareness of the amount of time spent sitting and its negative consequences on health. Barriers to reducing sedentary time included work and family routines, lack of time and willpower, age and sociocultural limitations. Facilitators identified were sociocultural change, free time and active work, and family surroundings. Participants recognized the abilities of health professionals to provide help and advice, and reported a preference for patient-centred or group interventions. Conclusions: Findings from this study have implications for reducing sedentary behaviour. Patient insights were used to design an intervention to reduce sitting time within the frame of the SEDESTACTIV clinical trial

Mean difference between before and after comprehensive smokefree legislation (SFL) in spirometry parameters.

<p>Abbreviations: CI, confidence interval; df, degrees of freedom; IV, Inverse Variance method.</p

Risk ratio between before and after comprehensive smokefree legislation (SFL) in asthma, COPD and lung infection admissions.

<p>Abbreviations: CI, confidence interval; df, degrees of freedom; IV, Inverse Variance method.</p

Risk difference between before and after the smokefree legislation (SFL) in any respiratory/sensory symptom.

<p>Abbreviations: CI, confidence interval; df, degrees of freedom; IV, Inverse Variance method.</p

Intervention for Smokers through New Communication Technologies: What Perceptions Do Patients and Healthcare Professionals Have? A Qualitative Study

<div><p>Background</p><p>The use of information and communication technologies (ICTs) in the health service is increasing. In spite of limitations, such as lack of time and experience, the deployment of ICTs in the healthcare system has advantages which include patient satisfaction with secure messaging, and time saving benefits and utility for patients and health professionals. ICTs may be helpful as either interventions on their own or as complementary tools to help patients stop smoking.</p><p>Objectives</p><p>To gather opinions from both medical professionals and smokers about an email-based application that had been designed by our research group to help smoking cessation, and identify the advantages and disadvantages associated with interventions based on the utilization of ICTs for this purpose.</p><p>Methods</p><p>A qualitative, descriptive–interpretative study with a phenomenological perspective was performed to identify and interpret the discourses of the participating smokers and primary healthcare professionals. Data were obtained through two techniques: semi-structured individual interviews and discussion groups, which were recorded and later systematically and literally transcribed together with the interviewer’s notes. Data were analyzed with the ATLAS TI 6.0 programme.</p><p>Results</p><p>Seven individual interviews and four focal groups were conducted. The advantages of the application based on the email intervention designed by our research group were said to be the saving of time in consultations and ease of access for patients who found work timetables and following a programme for smoking cessation incompatible. The disadvantages were thought to be a lack of personal contact with the healthcare professional, and the possibility of cheating/ self-deception, and a greater probability of relapse on the part of the smokers.</p><p>Conclusions</p><p>Both patients and healthcare professionals viewed the email-based application to help patients stop smoking as a complementary aid to face-to-face consultations. Nevertheless, ICTs could not substitute personal contact in the smoking cessation programme.</p></div