The impact of a comprehensive electronic patient portal on the health service use: an interrupted time-series analysis.

BACKGROUND: There is little empirical research on the potential benefit that electronic patient portals (EPP) can have on the care quality and health outcomes of diverse multi-ethnic international populations. The purpose of this study is to determine the extent to which an EPP was associated with improvements in health service use. METHODS: Using a quasi-experimental interrupted time-series approach, we assessed health service use before (April 2012-September 2015) and after (October 2015-December 2016) the implementation of a comprehensive EPP at four hospitals in Madrid, Spain. Primary outcomes were number of outpatient visits, any hospital admission, any 30-day all-cause readmission and any emergency department visit. RESULTS: Implementation of the EPP was associated with a significant decline in readmissions. Among patients with chronic heart failure, EPP implementation was associated with a significant decline for all outcome measures, and among patients with COPD, a decline in all outcomes except readmissions. Among patients diagnosed with malignant hematological diseases, no significant changes were identified. CONCLUSIONS: EPPs hold promise for reducing hospital readmissions. Certain patient populations with chronic conditions may differentially benefit from portal use depending on their needs for communication with their providers.

Hormona antimülleriana como predictor de respuesta ovárica. Revisión de la literatura y validación del test en nuestra unidad de reproducción asistida / Antimüllerian hormone as a predictor of ovarian response. Review of the literature and validation of the test in our assisted reproduction unit

Objetivo: evaluar la capacidad del test de hormona antimülleriana para predecir la baja o alta respuesta en pacientes usuarias de fecundación in vitro de nuestro centro. Se realiza una revisión bibliográfica sobre el papel del test de hormona antimülleriana en el estudio de la paciente infértil. Material y métodos: se trata de un estudio retrospectivo en 392 mujeres incluidas en nuestro programa de fecundación in vitro entre los años 2014-2015. A cada paciente se le extrajo una muestra de sangre para la determinación de hormona antimülleriana como parte del estudio básico de infertilidad. Tras la estimulación y punción ovárica, se correlacionó la hormona antimülleriana con el número de ovocitos obtenidos. Resultados: el valor de 0,29 ng/ml predijo la baja respuesta con una especificidad del 99%. El valor que mejor se comportó a la hora de predecir la alta respuesta fue 4,38 ng/ml con una sensibilidad del 87% y una especificidad de 84%. Conclusiones: la hormona antimülleriana nos ayuda a predecir la respuesta a la estimulación ovárica controlada en los ciclos de fecundación in vitro. Un valor de 0,29 ng/ml nos permite identificar la baja respuesta con un 99% de especificidad y un valor predictivo positivo del 86% en nuestra población. Nuestros puntos de corte son similares a los publicados en la literatura (AU)

Objective: Evaluate the potential of antimüllerian hormone levels to predict low or high response, in vitro fertilization patients treated by our centre. Perform a literature review of the use of antimüllerian hormone testing in the Investigation of infertile patients. Material and methods: We carried out a retrospective study of 392 women, who started treatment of in vitro fertilization between 2014 and 2015 in our reproductive unit. Each patient provided a blood sample as part of the basic infertility investigations; this was tested for levels of antimüllerian hormone. Following ovarian stimulation and harvest, the level of antimüllerian hormone was correlated with the number of oocytes extracted. Results: A Value of 0.29 ng/ml predicts low response with a specificity of 99%. The antimüllerian hormone level, which best correlated with a high response, was greater than 4.38 ng/ml, with high sensitivity (87%) and specificity (84%). Conclusions: Antimüllerian hormone levels help to predict response to controlled ovarian stimulation in cycles of in vitro fertilization. A Value of 0.29 ng/ml helps us to identify low likelihood of response, with a specificity of 99% and a positive predictive value of 86% in our population. Our cut-off points are similar to those reported in the literatura (AU)

Revisión del tratamiento del embarazo ectópico sobre cicatriz de cesárea previa. Una localización poco habitual / Review of the treatment of ectopic pregnancy in a previous cesarean section scar. A unusual location

La gestación implantada sobre cicatriz de cesárea previa es una forma poco habitual de embarazo ectópico, pero cuya incidencia ha aumentado en los últimos años en relación con las técnicas de reproducción asistida. Precisa de un diagnóstico temprano para poder minimizar las posibles complicaciones que pueden ocurrir (metrorragia, hemoperitoneo, rotura uterina,..). Disponemos de diferentes opciones diagnósticas y terapéuticas que revisaremos en este trabajo y que elegiremos en función de las características individuales de cada paciente (AU)

The pregnancy implanted on cesarean scar is a rare form of ectopic pregnancy, but whose incidence has increased in recent years in relation to assisted reproduction techniques. Accurate early diagnosis is needed in order to minimize the possible complications that can occur (metrorrhagia, hemoperitoneum, uterine rupture,..). We have different diagnostic and treatment options that will be reviewed in this paper and we will choose based on the individual characteristics of each patient (AU)