[Short-term and long-term evolution of deep vein thrombosis treated by a health care unit]. / Evolución a corto y largo plazo de la trombosis venosa profunda, tratada por una Unidad de Hospitalización a Domicilio.

INTRODUCTION AND OBJECTIVES: Deep vein thrombosis (DVT) is a common disease, with a high risk of complications persisting for years. Until recently, the treatment of this condition was on an hospitalary basis. Nevertheless, there is growing evidence suggesting an adequate management on an ambulatory basis with low molecular weight heparin (LMWH). Based upon these observations, and observational study was performed to determine short-term ad long-term complications of DVT treated by a Home Care Unit (HCU). METHODS: A total of 125 patients diagnosed of DVT by means of Doppler echography were treated on an ambulatory basis with subcutaneous nadroparine followed by oral anticoagulants (OAC) or LMWH alone, when a contraindication for acenocumarol use was present. The characteristics of the study population and their risk factors were studied, as well as the presence of bleeding or relapse during the acute period. Once the acute period with surveillance and treatment by the DHU was over, patients were followed at the Outpatient Clinics of the Internal Medicine Department. At each visit, the long-term complications were assessed: relapse, postflebitis syndrome (PFS), or death. RESULTS: The most common short-term complications were bleeding (3.2%) and relapse (7.3%). Eighteen percent of patients showed liver toxicity (increase of at least a 1.5 fold in the basal values of transaminases) secondary to the use of nadroparine. Nevertheless, this toxicity was mild in all cases and subsided when the medication was stopped. With a mean follow-up of 15.4 months, an overall 16.5% of patients relapsed, 25.8 % of patients had a PFS, and 23.7% of patients died. Death was associated with the presence of some risk factors (32.7% versus 7.69%; p = 0.004), and particularly when this risk factor was a tumor (75% versus 12%; p < 0.001). CONCLUSIONS: Deep vein thrombosis is a condition associated with common complications, both in the acute period and in the long-term. Nevertheless, it can be treated safely and efficiently by a HCU. This disease is associated with a high risk of mortality, particularly because it is usually associated with severe diseases.

Evolución a corto y largo plazo de la trombosis venosa profunda, tratada por una Unidad de Hospitalización a Domicilio / Short-term and long-term evolution of deep vein thrombosis treated by a health care unit

Introducción y objetivos. La trombosis venosa profunda (TVP) es una enfermedad frecuente, con un alto riesgo de complicaciones que persisten durante años. Hasta hace poco tiempo su tratamiento era intrahospitalario, sin embargo cada vez existe más evidencia sobre su manejo adecuado de forma ambulatoria con heparina de bajo peso molecular (HBPM). En base a esto se presenta un estudio observacional para determinar las complicaciones a corto y largo plazo de la TVP tratada por una Unidad de Hospitalización a Domicilio (HAD).Métodos. Ciento veinticinco pacientes diagnosticados por ecografia doppler de TVP fueron tratados de forma ambulatoria con nadroparina subcutánea seguida de anticoagulantes orales (ACO) o HPBM sólo, en caso de que existiese contraindicación para el acenocumarol. Se evaluaron las características de la población y sus factores de riesgo, así como la frecuencia de sangrado o recidiva durante el período agudo. Finalizado el período agudo con vigilancia y tratamiento por parte de la HAD se siguió a los pacientes en consultas externas de medicina interna, valorando en cada visita las complicaciones a largo plazo: recidiva, síndrome postflebítico (SPF) o exitus. Resultados. Las complicaciones más frecuentes a corto plazo fueron sangrado (3,2 por ciento) y recidiva (7,3 por ciento). Un 18,3 por ciento de los pacientes presentó hepatotoxicidad (aumento de más de 1,5 veces de las transaminasas basales) secundaria a la nadroparina; sin embargo, en todos los casos fue leve y desapareció al retirar la HBPM.Con una media de seguimiento de 15,4 meses, un 16,5 por ciento de los pacientes en total recidivó, un 25,8 por ciento tuvo SPF y 23,7 por ciento de los pacientes murió. La muerte se asoció a tener algún factor de riesgo (32,7 por ciento frente a 7,69 por ciento; p = 0,004), sobre todo a que este factor de riesgo fuese la presencia de un tumor (75 por ciento frente a 12 por ciento; p < 0,001). Conclusiones. La trombosis venosa profunda es una enfermedad con complicaciones frecuentes, tanto en el momento agudo como a largo plazo, pero que se puede tratar de forma segura y eficaz por HAD. Esta enfermedad presenta un elevado riesgo de mortalidad, condicionado sobre todo por su asociación con enfermedades graves (AU)

[Effectiveness of omeprazole, clarithromycin and amoxycillin therapy to eradicate Helicobacter pylori in patients with active peptic ulcer. Preliminary results of GENPY study]. / Efectividad de la combinación de omeprazol, claritromicina y amoxicilina en la erradicación de Helicobacter pylori en pacientes con ulcus péptico activo: resultados preliminares del Estudio GEHPY. Grupo de Estudio de Helicobacter pylori.

BACKGROUND: To compare the effectiveness of two length of the same therapy to eradicate Helicobacter pylori in patients with non complicated active peptic ulcer. PATIENTS AND METHODS: 223 patients visited at primary health centres. A randomised controlled trial was carried out to compare the results of 6 or 7 days of treatment with clarithromycin 500 mg, amoxicillin 1 g and omeprazole 20 mg, b.i.d. All patients received omeprazole for other 14 days. RESULTS: 108 patients were randomised to the 6 days group and 115 to the 7 days one. Both groups were comparable with respect to basic characteristics except for sex: the proportion of men was higher in the 6 days group (p = 0.04). 91.4% of the patients received all the treatment correctly. By intention to treat analysis, eradication rates were 76.9% in the 6 days group and 77.4% in the seven days group (IC 95% of the difference from -10.5 to 11.6). There were not statistically significant differences in eradication rates in relation to age, sex, ulcer location, recurrence or tobacco consumption. CONCLUSIONS: Although eradication rates are lower than expected, in this study there are no differences between 6 or 7 days of therapy.

[Analysis of prescriptions in primary care: evaluation of a system of indicators]. / Análisis de la prescripción en atención primaria: evaluación de un sistema de indicadores.

OBJECTIVE: To evaluate a system of qualitative indicators which serve as a tool for prioritising the level of intervention in Base Health Districts (BHDs). DESIGN: Retrospective, descriptive study. SETTING: Primary Care. MEASUREMENTS AND MAIN RESULTS: Medical prescription dispensed by the doctors from 36 BHDs in the Costa de Ponent (Barcelona) region in 1995 were analysed, with different qualitative indicators used. Three stages of indicators were established. 25% of the BHDs had a %PIV < 75%; 25% of them over 80%; and the rest between 75 and 80%. CONCLUSIONS: The three stages of indicators described contribute different and complementary information to the qualitative prioritising of pharmaceutical prescription. Absence of correlation between the third-stage indicators suggests the importance of choosing them according to the desired pharmacological group and in line with a pre-established criterion for selecting medicines.

[Non-steroid anti-inflammatory agents and gastrointestinal protection: adequate prescription in primary care?]. / Antiinflamatorios no esteroides y protección gastrointestinal: prescripción adecuada en atención primaria?

OBJECTIVES: To find the frequency of prescription of gastro-intestinal protectors (GIP) at the same time as non-steroidal anti-inflammatory drugs (NSAID). To find certain characteristics linked to their use in primary care. To evaluate how correctly they are prescribed. DESIGN: A crossover descriptive study. SETTING: A base urban health area. PATIENTS: Patients over 14, who attended in 1994, who had a medical history and were treated with NSAID. MEASUREMENTS AND INTERVENTIONS: 1,115 medical histories were obtained by simple randomised sampling, of whom 205 were under treatment with NSAID. A questionnaire was used to evaluate: age, sex, NSAID treatment, GIP, history of peptic ulcer, corticoid or acenocoumarol treatment, tobacco, alcohol and related pathology. After a complete bibliographic review, some criteria were fixed for when it is correct to give GIP-NSAID. RESULTS: The prevalence of NSAID prescription was 18.39%. 34 patients treated with NSAID received GIP at the same time. Aceclophenac was the most widely prescribed NSAID; and H2 antihistamines, the drugs most commonly used as GIP.

[Drug advertising in medical journals]. / Publicidad de medicamentos en las revistas médicas.

OBJECTIVE: To find the percentage of pages of advertising in 6 Spanish medical journals and compare their principal features with the criteria of the international committee of editors of medical journals. DESIGN: A descriptive crossover study. SETTING: The Spanish general medical journals with the highest circulation. PARTICIPANTS: All the issues of journals published between January and March 1993 (n = 56) were selected in order to calculate the average percentage of advertising. To analyse the adverts, all the adverts in 32 issues (n = 657) were selected by means of stratified random sampling of journals from the period July 1992 to June 1993. RESULTS: The average number of advertising pages was 39.16%. 7.8% were publicity articles with or without an advertisement. Adverts filled the best pages of the journals. In 11.7% of cases the adverts were connected with articles in the journal; in 23.9% they were inserted within article. 13.4% of the adverts analysed were for drug products with doubtful or nil intrinsic value; and 34.5% were pharmaceutical novelties (marketed after 1991). The therapeutic groups with most advertisements were ACE inhibitors (13.2%), analgesics (7.8%), calcium antagonists (7.2%) and AINE (7.2%). Paracetamol (6.1%) was the active principal advertised most often. CONCLUSION: The percentage of advertising seems excessive in all the journals except one and very much above the non-advertising informative material. There should be improvement by bringing journals into line with international editorial criteria.

[Evaluation of the impact of a care program for asthmatic children on the quality of anti-asthma drug prescriptions]. / Evaluación del impacto de un programa de atención al niño asmático sobre la calidad de la prescripción de fármacos antiasmáticos.

OBJECTIVE: To determine the influence of a programme of care for asthmatic children (CAC) on the quality of prescription of anti-asthmatic drugs. DESIGN: A controlled non-random intervention study. SETTING: Paediatric clinics operating before 1991 in Health Districts (HD) of Hospitalet. PARTICIPANTS: INTERVENTION GROUP: All the paediatricians ranked in the HD where the programme was set up (n = 3). CONTROL GROUP: All the paediatricians ranked in the rest of the HD (n = 9). INTERVENTION: In april 1992 the CAC programme, which included a pharmaco-therapeutic procedure, was set up in the HD. MEASUREMENTS AND MAIN RESULTS: Prescriptions were evaluated by looking at the billing data of the Catalan Health Service between january and april, 1991, 1992 and 1993. The following Quality Indicators were evaluated: 1. Percentage of dosage of beta 2 adrenergics inhaled as against the total of beta 2 (oral and inhaled). 2. Percentage of DHD of Nedocromil (NC) and Cromoglycate (CG) as against the total of preventive drugs (NC + CG + Ketotifen). 3. Number of packages of oral and/or rectal Theophyllines, counter-indicated combinations and anti-inflammatory drugs (Chromones and inhaled steroids). CONCLUSION: The influence of the programme can be considered very positive, since an increase in all the quality indicators of the prescription of anti-asthmatics was observed, something that did not occur in the Control Group.

[Improving drug prescription in primary care: a controlled and randomized study of an educational method]. / Mejorar la prescripción de fármacos en atención primaria: un estudio controlado y aleatorio sobre un método educativo.

BACKGROUND: The aim of the present study was to assess whether educational intervention on the primary care physician may be an effective method to improve drug prescription. METHODS: An experimental randomized controlled study was carried out in 244 physicians of the management area No. 5 of the Institut Català de la Salut. Intervention consisted in 3 individualized interviews with the 123 physicians of the study group (IG), during which written informative material was also presented. The issues were: cerebral and peripheral vasodilators (CPVD) and antibiotics. The changes in the prescription of CPVD, combination of anti-infective agents with expectorants, mucolytics and/or balsamics (R05C1) and cephalosporins were specially evaluated in both groups. Subsequently, a stratified analysis was carried out depending on the volume of prescription of the physicians. RESULTS: The IG showed a greater reduction in the prescription of CPVD (9.78 bottles per physicians and months versus 6.43, p less than 0.01). The relative reduction in R05C1 prescription was also higher in the IG (12.3% versus 6.7%, p less than 0.01). The expenditure showed similar results. The use of oral cephalosporins increased in the IG and was reduced in the CG (p less than 0.01). CONCLUSIONS: The results show a favorable impact of personalized information in the groups with high prescription volume, which is particularly remarkable in the highest prescribers.

[A quantitative study of the consumption of antihypertensives in Management Area 5 of the ICS (Costa de Ponent). Institut Català de la Salut]. / Estudio cuantitativo del consumo de antihipertensivos (AHT) en el Area de Gestión 5 del ICS (Costa de Ponent).

The use of antihypertensive drugs (AHD) in the area n degrees 5 of the Institut Català de la Salut was evaluated for the period October 1986-December 1987. The unit of measure was the DDD (daily defined dose) per 1,000 population individuals per day. The overall use of AHD in 1987 was 49.31 DDDs/1,000 individuals/day; it was distributed among diuretics (53.5% of all AHD), beta-blockers (11.3%), and other AHD (35.2%). The most commonly prescribed drugs, by decreasing frequency order, were combinations of low ceiling diuretics with potassium sparing drugs, and of rauwolfia alkaloids with diuretics, followed by nifedipine, chlortalidone and furosemide. The interannual evaluation disclosed an increase of 18.6% in 1987 as compared with the preceding year, mostly at the expense of beta-blockers. On the other hand, there was a tendency to refrain from the use of fixed dose drug associations. This is a criterion of better use of antihypertensive therapy.