Adaptation and psychometric validation of Diabetes Health Profile (DHP-18) in patients with type 2 diabetes in Quito, Ecuador: a cross-sectional study

Diabetes mellitus; Ecuador; FiabilidadDiabetis mellitus; Equador; FiabilitatDiabetes mellitus; Ecuador; ReliabilityIntroduction The Diabetes Health Profile (DHP‐18), structured in three dimensions (psychological distress (PD), barriers to activity (BA) and disinhibited eating (DE)), assesses the psychological and behavioural burden of living with type 2 diabetes. The objectives were to adapt the DHP‐18 linguistically and culturally for use with patients with type 2 DM in Ecuador, and to evaluate its psychometric properties. Methods Participants were recruited using purposive sampling through patient clubs at primary health centres in Quito, Ecuador. The DHP-18 validation consisted in the linguistic validation made by two Ecuadorian doctors and eight patient interviews. And in the psychometric validation, where participants provided clinical and sociodemographic data and responded to the SF-12v2 health survey and the linguistically and culturally adapted version of the DHP-18. The original measurement model was evaluated with confirmatory factor analysis (CFA). Reliability was assessed through internal consistency using Cronbach’s alpha and test–retest reproducibility by administering DHP-18 in a random subgroup of the participants two weeks after (n = 75) using intraclass correlation coefficient (ICC). Convergent validity was assessed by establishing previous hypotheses of the expected correlations with the SF12v2 using Spearman’s coefficient. Results Firstly, the DHP-18 was linguistically and culturally adapted. Secondly, in the psychometric validation, we included 146 participants, 58.2% female, the mean age was 56.8 and 31% had diabetes complications. The CFA indicated a good fit to the original three factor model (χ2 (132) = 162.738, p  −0.40 in two of three hypotheses). Conclusions The original three factor model showed good fit to the data. Although reliability parameters were adequate for PD and DE dimensions, the BA presented lower internal consistency and future analysis should verify the applicability and cultural equivalence of some of the items of this dimension to Ecuador.This research was funded by a H2020 European Research Council 2018 Starting Grant, Grant Number 804761—CEAD

Registros de cirugía cardíaca: revisión internacional

Registres; Cirurgia cardíaca; Nivell internacionalRegistros; Cirugía cardíaca; Nivel internacionalRecords; Heart surgery; International levelObjective: to assess, in the currently available continuous registries of cardiac surgicalprocedures, features regarding authorship, outcome variables, quality control, their consequences for the quality of care, and bibliometric impact. Methods: 1) A systematic review of the information published on the medical literature or reported in the Internet, and 2) A structured survey addressed to persons identifi ed as representative of the recovered registries. Results: twenty-eight registries fulfi lling the inclusion criteria were identifi ed. Using the survey and the review of web pages additional data were obtained of 9 more registries. Most registries were based on national or regional initiatives or from scientifi c societies and their principal aim was quality of care improvement. Their authors were predominantly cardiac surgeons. Most registries only recorded in-hospital events, and from most of them internal documents that were returned to participants for feedback were generated. Although in most registries some quality control measures were undertaken, these were not comprehensive. Several registries generated articles in high impact journals. Greater impact corresponded to those registries that were associated with intensive and widespread campaigns for quality improvement or with collateral Studies derived from the registry.Objetivo: evaluar, en los registros continuos de cirugía cardíaca actualmente existentes a nivel internacional, sus características de autoría, variables de resultado, control de calidad, infl uencia en la calidad asistencial e impacto bibliométrico. Métodos: 1) Revisión sistemática de la información publicada en la literatura médica y en Internet. 2) Realización de una encuesta estructurada a los responsables de los registros identificados. Resultados: se identifi caron 28 registros que cumplían los criterios de inclusión. Mediante encuesta y revisión de página web se obtuvieron datos adicionales de 9 de ellos. La gran mayoría correspondían a iniciativas nacionales, regionales o de sociedades científicas para mejoría de la calidad asistencial. Los autores predominantes eran cirujanos cardíacos. La mayoría de registros contemplaban sólo resultados intrahospitalarios, y en la mayoría se generaban documentos internos que retornaban la información correspondiente a los participantes. A pesar de que en la mayoría se realizaban actividades de control de calidad, éstas no eran exhaustivas. Varios de los registros generaron publicaciones científi cas de impacto. El mayor de éstos correspondió a registros asociados a campañas intensas y ampliamente difundidas de mejoría de la calidad o a estudios colaterales derivados del propio registro.Objectiu: avaluar, en els registres continus de cirurgia cardíaca actualment existents a nivell internacional, les seves característiques d'autoria, variables de resultat, control de qualitat, influència en la qualitat assistencial i impacte bibliomètric. Mètodes: 1) Revisió sistemàtica de la informació publicada a la literatura mèdica ia Internet. 2) Realització d'una enquesta estructurada als responsables dels registres identificats. Resultats: es identificació car 28 registres que complien els criteris d'inclusió. mitjançant enquesta i revisió de pàgina web es van obtenir dades addicionals de 9 d'ells. La gran majoria corresponien a iniciatives nacionals, regionals o de societats científiques per a millora de la qualitat assistencial. Els autors predominants eren cirurgians cardíacs. La majoria de registres contemplaven només resultats intrahospitalaris, i en la majoria es generaven documents interns que retornaven la informació corresponent als participants. Tot i que en la majoria es realitzaven activitats de control de qualitat, aquestes no eren exhaustives. Diversos dels  registres van generar publicacions científiques ques d'impacte. El major d'aquests va correspondre a registres associats a campanyes intenses i àmpliament difoses de millora de la qualitat o a estudis col·laterals derivats del propi registre

Desfibrilador automático implantable para prevención primaria de la muerte súbita cardíaca en España: eficacia, seguridad y eficiencia

Desfibrilador automático implantable; Muerte súbita cardíaca; Prevención primariaImplantable cardioverter defibrillator; Sudden cardiac death; Primary preventionDesfibril·lador automàtic implantable; Mort sobtada cardíaca; Prevenció primàriaInforme que té com a objectius analitzar nova evidència disponible i conèixer el valor actual del cost-utilitat del DAI, més el tractament mèdic convencional (TMC) enfront de TMC per a prevenció primària d’arrítmies cardíaques des de la perspectiva del Sistema Nacional de Salut (SNS).Report that report that aims to analyze new available evidence and to know the current value of the cost-utility of the Implantable Cardioverter Defibrillator (ICD) plus Conventional Medical Treatment (CCT) versus CCT for primary prevention of cardiac arrhythmias from the perspective of the Spanish National Health System (SNS).Informe que tiene como objetivo analizar nueva evidencia disponible y conocer el valor actual del coste-utilidad del Desfibrilador Automático Implantable (DAI) más Tratamiento Médico Convencional (TMC) frente a TMC para prevención primaria de arritmias cardiacas desde la perspectiva del Sistema Nacional de Salud (SNS)

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

COVID-19; Síndrome coronario agudo; Insuficiencia cardiacaCOVID-19; Síndrome coronària aguda; Insuficiència cardíacaCOVID-19; Acute coronary syndrome; Heart failureAims: This 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 Results: We 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. Conclusion: During 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.This study was funded with a grant from Sociedad Española de Cardiología y Fundación Española del Corazón (SEC/FEC-INV-CLI 21/017). The funder had no role in the study development

Data and care integration for post-acute intensive care program of stroke patients: effectiveness assessment using a disease-matched comparator cohort

Sistemes d'informació, Atenció integrada; Ictus; Atenció domiciliàriaSistemas de información; Atención integrada; Ictus; Atención domiciliariaInformation systems; Integrated care; Stroke; Domiciliary carePurpose: to assess the effectiveness of an integrated care program for post-acute care of stroke patients, the return home program (RHP program), deployed in Barcelona (North-East Spain) between 2016 and 2017 in a context of health and social care information systems integration. Design/methodology/approach: the RHP program was built around an electronic record that integrated health and social care information (with an agreement for coordinated access by all stakeholders) and an operational re-design of the care pathways, which started upon hospital admission instead of discharge. The health outcomes and resource use of the RHP program participants were compared with a population-based matched control group built from central healthcare records of routine care data. Findings: the study included 92 stroke patients attended within the RHP program and the patients’ matched controls. Patients in the intervention group received domiciliary care service, home rehabilitation, and telecare significantly earlier than the matched controls. Within the first two years after the stroke episode, recipients of the RHP program were less frequently institutionalized in a long-term care facility (5 vs 15%). The use of primary care services, non-emergency transport, and telecare services were more frequent in the RHP group

Sample size requirement in trials that use the composite endpoint major adverse cardiovascular events (MACE): new insights

Composite endpoints; Correlation; Sample sizePuntos finales compuestos; Correlación; Tamaño de la muestraPunts finals compostos; Correlació, Grandària de la mostraBackground The real impact of the degree of association (DoA) between endpoint components of a composite endpoint (CE) on sample size requirement (SSR) has not been explored. We estimate the impact of the DoA between death and acute myocardial infarction (AMI) on SSR of trials using use the CE of major adverse cardiac events (MACE). Methods A systematic review and quantitative synthesis of trials that include MACE as the primary outcome through search strategies in MEDLINE and EMBASE electronic databases. We limited to articles published in journals indexed in the first quartile of the Cardiac & Cardiovascular Systems category (Journal Citation Reports, 2015–2020). The authors were contacted to estimate the DoA between death and AMI using joint probability and correlation. We analyzed the SSR variation using the DoA estimated from RCTs. Results Sixty-three of 134 publications that reported event rates and the therapy effect in all component endpoints were included in the quantitative synthesis. The most frequent combination was death, AMI, and revascularization (n = 20; 31.8%). The correlation between death and AMI, estimated from 5 trials¸ oscillated between − 0.02 and 0.31. SSR varied from 14,602 in the scenario with the strongest correlation to 12,259 in the scenario with the weakest correlation; the relative impact was 16%. Conclusions The DoA between death and AMI is highly variable and may lead to a considerable SSR variation in a trial including MACE.Intramural CIBER-ESP PR22 from the Center for Biomedical Research in Epidemiology and Public Health Network (CIBERESP)

Segon audit clínic de l’ictus: Catalunya 2008

Audit clínic; Ictus; AvaluacióAudit clínico; Ictus; EvaluaciónClinical audit; Stroke; EvaluationEl document que esteu llegint presenta els resultats del Segon Audit de l’Ictus, realitzat entre febrer i juny del 2008, la part clínica del qual es basa en la revisió d’històries clíniques de pacients amb ictus ingressats consecutivament a partir del gener del 2007 en els 48 hospitals de l’XHUP. La part estructural d’aquest audit descriu la situació dels equipaments, recursos humans i organitzatius per a l’atenció al malalt amb ictus al 2008.Aquest Segon Audit de l’ictus ha estat cofinançat per la Direcció General de Planificació i Avaluació i pel projecte de recerca 05/2709 del Fondo de Investigación Sanitaria, Instituto de Salud Carlos III

Primer audit clínic de l’ictus: Catalunya 2006

Audit clínic; Ictus; AvaluacióAudit clínico; Ictus; EvaluaciónClinical audit; Stroke; EvaluationAquest document presenta els resultats de l’audit clínic i descriu els recursos per a l’atenció a l’ictus a nivell de Catalunya, analitzant la situació dels diferents territoris i nivells hospitalaris.Aquest ’Primer Audit Clínic de l’Ictus’ ha estat finançat amb el projecte de recerca 05/2709 del ‘Fondo de Investigación Sanitaria’

Trends in healthcare resource use and expenditure before and after ischaemic stroke. A population-based study

Ischaemic stroke; Resource use; Healthcare expenditureIctus isquémico; Uso de recursos; Gasto sanitarioIctus isquèmic; Ús de recursos; Despesa sanitàriaIntroduction Despite improved survival rates, stroke represents an increasing healthcare and socioeconomic burden. We describe the main characteristics of patients with ischaemic stroke and resource use and associated expenditure one year before and 3 years after stroke, using a population-based dataset. Methods The information technology systems of the Catalan Health Service were used to identify patients with ischaemic strokes occurring between January 2012 and December 2016. For each patient, information from one year before the stroke and up to 3 years thereafter was linked across databases. We describe annual and monthly resource use and healthcare expenditure per patient. Results We identified 36 044 patients with ischaemic stroke (mean age, 74.7 ± 13.3 years). The survival rate at 3 years was 63%. Average expenditure per patient was €3230 the year before stroke, €11 060 for year 1 after stroke, €4104 for year 2, and €3878 for year 3. The greatest determinants of cost in year 1 were hospitalisation (including initial hospitalisation), representing 45% of the difference in expenditure compared to the previous year, and convalescence and rehabilitation services, representing 33% of this difference. After year one, the increase in expenditure was mainly determined by additional hospital admissions and drug treatment. Conclusion After ischaemic stroke, healthcare expenditure increases primarily because of initial hospitalisation. After year one, the expenditure decreases but remains above baseline values. Information from population-based datasets is useful for improving the planning of stroke services.Introducción A pesar del aumento de la supervivencia, el ictus representa una carga en salud y socioeconómica creciente. Mediante el uso de bases de datos poblacionales describimos las características principales de los pacientes con ictus isquémico y comparamos el uso de recursos y el gasto asociado un año antes y 3 años después del evento. Métodos Se identificaron en los sistemas de Información del Servicio Catalán de la Salud todos los pacientes con ictus isquémico entre los años 2012 y 2016. Se relacionaron todos los contactos con el sistema sanitario desde un año antes del episodio índice hasta 3 años después. Se describió el uso de recursos y el gasto sanitario mensual y anual por paciente en los distintos recursos. Resultados Se identificaron 36.044 pacientes con ictus isquémico, edad media (DE) de 74,7 (13,3) años. La supervivencia a los 3 años fue del 63%. El gasto medio por paciente en el año previo fue de 3.230€, de 11.060€ el primer año desde el ictus, de 4.104€ el segundo y 3.878€ el tercero. Los mayores determinantes de gasto en el primer año fueron las hospitalizaciones (incluyendo la hospitalización inicial), representando el 45% de la diferencia con respecto al año previo al ictus, y en segundo lugar el gasto en convalecencia y rehabilitación (un 33%). Después del primer año, los mayores determinantes del incremento en el gasto respecto al año previo fueron las nuevas hospitalizaciones y el tratamiento farmacológico. Conclusión Después de un ictus isquémico, el gasto en atención sanitaria aumenta principalmente por las necesidades iniciales de hospitalización y después del primer año se reduce, aunque manteniéndose por encima de los valores previos al ictus. La información derivada de bases de datos poblacionales es útil para mejorar la organización de los servicios de atención al ictus.This study has received no funding

Recomanacions per a l’organització del tractament del xoc cardiogènic a Catalunya: via xoc

Xoc cardiogènic; Tractament; Via xocCardiogenic shock; Treatment; Via xoc;Choque cardiogénico; Tratamiento; Via xocEl xoc cardiogènic (XC) és una situació de baix cabal cardíac que s’associa a hipoperfusió i fallida orgànica multisistèmica. La causa més freqüent és l’infart agut de miocardi amb disfunció greu del ventricle esquerre. Els avenços en la teràpia de reperfusió han millorat la supervivència del XC, però la mortalitat intrahospitalària continua sent elevada (al voltant del 50%). Els sistemes coordinats regionals d’atenció mèdica, associats a algorismes de tractament comuns, han millorat la supervivència en patologies agudes greus en què el pronòstic és dependent del temps (infart agut de miocardi [IAM], accident vascular cerebral, aturada cardíaca extrahospitalària, politraumatisme). Aplicar una estratègia similar adaptada al XC podria tenir un efecte similar en la seva supervivència.Cardiogenic shock (CS) is a situation of low cardiac output that is associated with hypoperfusion and multisystemic organ failure. The most common cause is acute myocardial infarction with severe left ventricular dysfunction. Advances in reperfusion therapy have improved CS survival, but in-hospital mortality remains high (around 50%). Coordinated regional health care systems, associated with common treatment algorithms, have improved survival in severe acute conditions in which the prognosis is time-dependent (acute myocardial infarction [AMI], stroke, outpatient cardiac arrest, polytrauma). Applying a similar strategy adapted to the CS could have a similar effect on its survival.El shock cardiogénico (SC) es una situación de bajo gasto cardíaco que se asocia a hipoperfusión y quiebra orgánica multisistémica. La causa más frecuente es el infarto agudo de miocardio con disfunción grave del ventrículo izquierdo. Los avances en la terapia de reperfusión han mejorado la supervivencia del SC, pero la mortalidad intrahospitalaria sigue siendo elevada (alrededor del 50%). Los sistemas coordinados regionales de atención médica, asociados a algoritmos de tratamiento comunes, han mejorado la supervivencia en patologías agudas graves en que el pronóstico es dependiente del tiempo (infarto agudo de miocardio [IAM], accidente vascular cerebral, paro cardíaco extrahospitalaria, politraumatismo). Aplicar una estrategia similar adaptada al SC podría tener un efecto similar en su supervivencia