El risc de la cirurgia coronària a Catalunya: mètodes i usos de la seva avaluació

L'objectiu d'aquest treball era avaluar la mortalitat hospitalària de la cirurgia coronaria en malalts de la sanitat pública operats en centres de gestió pública i privada de Catalunya, mitjançant l'ús de dues escales de risc (l'EuroSCORE i un model d'àmbit local). S'analitzà també la validesa dels mètodes d'avaluació i es comparà el resultat de la cirurgia sense circulació extracorpòria respecte de la cirurgia amb circulació extracorpòria. Es van incloure tots els malalts consecutius (1.605) sotmesos a una primera intervenció d'empelt coronari aïllat durant dos anys en cinc hospitals. Els resultats indiquen que a Catalunya: 1) La gestió privada del centre s'associa marginalment amb una millor supervivència. 2) L'efectivitat de la cirurgia coronària a millorat en els últims anys. 3) Ambdós instruments d'ajust del risc son útils per a l'avaluació d'aquests resultats. 4) La cirurgia sense circulació extracorpòria s'associa a millors resultats, sobre tot en els pacients amb risc preoperatori baix.El objetivo de este trabajo era evaluar la mortalidad hospitalaria de la cirugía coronaria de los pacientes de la sanidad pública operados en centros de gestión pública y privada de Cataluña, mediante dos escalas de riesgo (el EuroSCORE y una de ámbito local). Se analizó también la validez de los métodos de evaluación y se comparó el resultado de la cirugía sin circulación extracorporea con el de la cirugía con circulación extracorporea.Se incluyeron los pacientes (1.605) sometidos a una primera intervención de implante aortocoronario aislado durante dos años en cinco centros.Los resultados indican que en Cataluña: La gestión privada se asocia marginalmente a mejor supervivencia. La efectividad de la cirugía coronaria ha mejorado en los últimos años. Ambos instrumentos de ajuste del riesgo resultan útiles para la evaluación de estos resultados. La cirugía sin circulación extracorporea se asocia a mejores resultados, sobre todo en pacientes de riesgo bajo.The objective of the present study was to evaluate hospital mortality after coronary surgery in patients from the public health system operated on in public and private centers, using two risk scores (the EuroSCORE and a locally derived model). In addition, validity of such evaluating methods was assessed and the results of off-pump and on-pump coronary surgery were compared.All consecutive patients (1.605) undergoing a first isolated coronary by-pass procedure during two years were recruited in five hospitals.The results show that in Catalonia: 1) Private hospital management is associated to a maginal increase in hospital survival. 2) Effectiveness of coronary by-pass surgery has increased compared to previous evaluations. 3) Both risk scores showed complementary properties fort he evaluation of results. 4) Off-pump coronary surgery is associated to better results and the association is grater in low risk patients

NYAM: the role of configurable engagement strategies in robotic-assisted feeding

© 2024 Copyright held by the owner/author(s). Publication rights licensed to ACM.In some contexts, like geriatric hospitals, the number of patients requiring assistance with feeding is very high and robots may be an effective tool for caregivers to provide better assistance. This article introduces NYAM, a robot designed to aid in the feeding process for individuals. Our robot is equipped with a mechanism to effectively recapture the person's attention whenever necessary. The mechanism is easily adjustable by the caregivers, allowing the straightforward customisation of the feeding service. The approach was evaluated, within a geriatric hospital, with 9 patients who used the robot for 5 consecutive days. We argue that incorporating enhanced social aspects into the robot is imperative to enhance the effectiveness and acceptance of this solution. © 2024 Copyright held by the owner/author(s)This work was supported by the project ROB-IN PLEC2021-007859 funded by MCIN/ AEI /10.13039/501100011033 and by the "European Union NextGenerationEU/PRTR"; project CHLOE-GRAPH PID2020-118649RB-I00 funded by MCIN/ AEI /10.13039/501100011033; and project PIONEER from PSPV.Peer ReviewedPostprint (published version

Patient-centered care in Coronary Heart Disease: what do you want to measure? A systematic review of reviews on patient-reported outcome measures

Background: The number of published articles on Patient-Reported Outcomes Measures (PROMs) in Coronary Heart Disease (CHD), a leading cause of disability-adjusted life years lost worldwide, has been growing in the last decades. The aim of this study was to identify all the disease-specific PROMs developed for or used in CHD and summarize their characteristics (regardless of the construct), to facilitate the selection of the most adequate one for each purpose. Methods: A systematic review of reviews was conducted in MEDLINE, Scopus, and the Cochrane Database of Systematic Reviews. PROQOLID and BiblioPRO libraries were also checked. PROMs were classified by construct and information was extracted from different sources regarding their main characteristics such as aim, number of items, specific dimensions, original language, and metric properties that have been assessed. Results: After title and abstract screening of 1224 articles, 114 publications were included for full text review. Finally, we identified 56 PROMs: 12 symptoms scales, 3 measuring functional status, 21 measuring Health-Related Quality of Life (HRQL), and 20 focused on other constructs. Three of the symptoms scales were specifically designed for a study (no metric properties evaluated), and only five have been included in a published study in the last decade. Regarding functional status, reliability and validity have been assessed for Duke Activity Index and Seattle Angina Questionnaire, which present multiple language versions. For HRQL, most of the PROMs included physical, emotional, and social domains. Responsiveness has only been evaluated for 10 out the 21 HRQL PROMs identified. Other constructs included psychological aspects, self-efficacy, attitudes, perceptions, threats and expectations about the treatment, knowledge, adjustment, or limitation for work, social support, or self-care. Conclusions: There is a wide variety of instruments to assess the patients' perspective in CHD, covering several constructs. This is the first systematic review of specific PROMs for CHD including all constructs. It has practical significance, as it summarizes relevant information that may help clinicians, researchers, and other healthcare stakeholders to choose the most adequate instrument for promoting shared decision making in a trend towards value-based healthcare

Dynamics of Emergency Cardiovascular Hospital Admissions and In-Hospital Mortality During the COVID-19 Pandemic: Time Series Analysis and Impact of Socioeconomic Factors

AimsThis study aimed to evaluate the decline in urgent cardiovascular hospital admissions and in-hospital mortality during the COVID pandemic in two successive waves, and to evaluate differences by sex, age, and deprivation index subgroups. Methods and ResultsWe obtained acute cardiovascular hospital episodes during the years 2019-2020 from region-wide data on public healthcare usage for the population of Catalonia (North-East Spain). We fitted time models to estimate the incidence rate ratios (IRRs) of the acute coronary syndrome (ACS) and acute heart failure (HF) admissions during the first pandemic wave, the between-waves period, and the second wave compared with the corresponding pre-COVID-19 periods and to test for the interaction with sex, age, and area-based socioeconomic level. We evaluated the effect of COVID-19 period on in-hospital mortality. ACS (n = 8,636) and HF (n = 27,566) episodes were defined using primary diagnostic ICD-10 codes. ACS and HF admissions decreased during the first wave (IRR = 0.66, 95%CI: 0.58-0.76 and IRR = 0.61, 95% CI: 0.55-0.68, respectively) and during the second wave (IRR = 0.80, 95%CI: 0.72-0.88 and IRR = 0.76, 95%CI: 0.69-0.84, respectively); acute HF admissions also decreased in the period between waves (IRR: 0.81, 95%CI: 0.74-0.89). The impact was similar in all sex and socioeconomic subgroups and was higher in older patients with ACS. In-hospital mortality was higher than expected only during the first wave. ConclusionDuring the first wave of the COVID-19 pandemic, there was a marked decline in urgent cardiovascular hospital admissions that were attenuated during the second wave. Both the decline and the attenuation of the effect have been similar in all subgroups regardless of age, sex, or socioeconomic status. In-hospital mortality for ACS and HF episodes increased during the first wave, but not during the second wave

Predicted clinical and economic burden associated with reduction in access to acute coronary interventional care during the COVID-19 lockdown in two European countries.

AimsAs a consequence of untimely or missed revascularization of ST-elevation myocardial infarction (STEMI) patients during the COVID-19 pandemic, many patients died at home or survived with serious sequelae, resulting in potential long-term worse prognosis and related health-economic implications.This analysis sought to predict long-term health outcomes [survival and quality-adjusted life-years (QALYs)] and cost of reduced treatment of STEMIs occurring during the first COVID-19 lockdown.Methods and resultsUsing a Markov decision-analytic model, we incorporated probability of hospitalization, timeliness of PCI, and projected long-term survival and cost (including societal costs) of mortality and morbidity, for STEMI occurring during the first UK and Spanish lockdowns, comparing them with expected pre-lockdown outcomes for an equivalent patient group.STEMI patients during the first UK lockdown were predicted to lose an average of 1.55 life-years and 1.17 QALYs compared with patients presenting with a STEMI pre-pandemic. Based on an annual STEMI incidence of 49 332 cases, the total additional lifetime costs calculated at the population level were £36.6 million (€41.3 million), mainly driven by costs of work absenteeism. Similarly in Spain, STEMI patients during the lockdown were expected to survive 2.03 years less than pre-pandemic patients, with a corresponding reduction in projected QALYs (−1.63). At the population level, reduced PCI access would lead to additional costs of €88.6 million.ConclusionThe effect of a 1-month lockdown on STEMI treatment led to a reduction in survival and QALYs compared to the pre-pandemic era. Moreover, in working-age patients, untimely revascularization led to adverse prognosis, affecting societal productivity and therefore considerably increasing societal costs