11 research outputs found

    Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

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    This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

    Prueba del Derecho extranjero y tutela judicial efectiva

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    Inmigración ilegal y justicia gratuita

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    Adopción internacional y tráfico de niños

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    El derecho al respeto a la vida familiar (art. 8.1 CEDH): una aproximación "iusprivatista" desde el recurso de amparo

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    The Spanish Constitutional Court states that there is not a fundamental right to family life protected by the amparo appeal, such as the right to respect for family life recognised in Article 8.1 European Convention on Human Rights. This paper focuses on the exceptions to the rule, as well as on the way the right to family life is used by constitutional judgments as a requirement of reasoning and the potential of this solution. Finally, it analyses the effect the Spanish law reforms of the amparo appeal and the legal procedure to execute the ECHR judgments could have in order to correctly measure the impact of this statement.Partiendo de la doctrina constitucional que niega la existencia de un derecho fundamental a la vida familiar ex art. 18.1 CE protegible en amparo, coextenso al derecho al respeto a la vida familiar recogido en el art. 8.1 CEDH, el presente trabajo constata la existencia de excepciones en la doctrina, así como la progresiva penetración del derecho a la vida familiar en el recurso de amparo bajo la forma de parámetro de motivación de las resoluciones judiciales (art. 24.1 CE), y destaca el potencial de esta solución. Finalmente plantea si y en qué medida los efectos negativos de esta doctrina se ven atemperados por factores como la objetivación del recurso de amparo y la reforma legislativa que establece el cauce procesal para la reapertura del procedimiento, a resultas de condena por el TEDH

    Inclusive classroom: university and integration of people with intellectual disabilities in training on legal documentation

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    El proyecto tiene como finalidad la inclusión de las personas con Discapacidad Intelectual (DI) en la Universidad, estableciendo un intercambio en el aula y en el conjunto de las actividades con el alumnado universitario y preuniversitario.The project aims at the inclusion of people with Intellectual Disabilities (DI) in the University, establishing an exchange in the classroom and in all activities with university and pre-university students.Depto. de Derecho AdministrativoFac. de DerechoFALSEsubmitte
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