ABSTRACT
OBJETIVO: El objetivo de este estudio ha sido conocer las características de los pacientes EPOC por fenotipos y según la GOLD 2011-ABCD y el grado de concordancia de los tratamientos farmacológicos. DISEÑO: Estudio transversal de observación y descriptivo. Emplazamiento Pacientes EPOC entre 40 y 85años pertenecientes al Área de León que figuran en la base de datos MEDORA de Atención Primaria. PARTICIPANTES: De los 5.522 pacientes recogidos en la base de datos de MEDORA con los criterios de selección descritos, se calculó un tamaño muestral de 734 sujetos, de los cuales se estudiaron finalmente 577 enfermos. Mediciones principales: Se diseñó un cuestionario estructurado para recoger la información sociodemográfica, clínica, tratamientos y calidad de vida. Se incluía realización de espirometría y prueba broncodilatadora. RESULTADOS: De los 734 enfermos muestreados se ha conseguido estudiar al 78,6% (577). En 166 pacientes (28,7%), el diagnóstico había sido realizado exclusivamente por la clínica, sin constancia de espirometría en el MEDORA. En 123 (21,3%) el índice FEV1/FVC fue superior a 0,7, por lo que se descartó el diagnóstico de EPOC. Con respecto a los tratamientos prescritos según fenotipos, observamos que en el fenotipo no agudizador existe una sobreprescripción de corticoides inhalados. Lo mismo sucede en los grupos A y B. CONCLUSIONES: A pesar de las guías clínicas, el manejo de los pacientes con EPOC en la vida real sigue siendo mejorable, tanto en el aspecto diagnóstico como de medidas terapéuticas
OBJECTIVE: The purpose of this study was to evaluate different characteristics of COPD patients according to phenotypes and GOLD guidelines.according to GesEPOC phenotypes and GOLD 2011 ABCD guidelines and pharmacological treatment agreement. DESIGN: Cross-sectional survey. LOCATION: COPD patients aged 40-85 from León were randomly selected from Primary Care database, MEDORA. PARTICIPANTS: 5222 eligible COPD patients were collected from MEDORA database. We calculated a sample size of 734 patients and finally studied 577 of them. MAIN MEASUREMENTS: Patients clinical, functional and health related quality of life information were collected. Spirometry and postbroncodilator test were performed. RESULTS: A total of 577 patients were included in this study. 28.7% of them did not have a spirometry recorded in their files. 123 patients had a normal or non-obstructive spirometry pattern, so they were excluded from a COPD diagnostic. With regard to treatments, there was an overprescribing of inhaled steroids in patients from GOLD A and B groups, and also in patients with the called exacerbator phenotype (GesEPOC). CONCLUSION: Although there have been several published guidelines, management of COPD patients in real life should be improved
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Pulmonary Disease, Chronic Obstructive/epidemiology , Respiratory Function Tests/statistics & numerical data , Symptom Flare Up , Cross-Sectional Studies , Primary Health Care/statistics & numerical data , Phenotype , Quality of LifeABSTRACT
OBJECTIVE: The purpose of this study was to evaluate different characteristics of COPD patients according to phenotypes and GOLD guidelines.according to GesEPOC phenotypes and GOLD 2011 ABCD guidelines and pharmacological treatment agreement. DESIGN: Cross-sectional survey. LOCATION: COPD patients aged 40-85 from León were randomly selected from Primary Care database, MEDORA. PARTICIPANTS: 5222 eligible COPD patients were collected from MEDORA database. We calculated a sample size of 734 patients and finally studied 577 of them. MAIN MEASUREMENTS: Patients clinical, functional and health related quality of life information were collected. Spirometry and postbroncodilator test were performed. RESULTS: A total of 577 patients were included in this study. 28.7% of them did not have a spirometry recorded in their files. 123 patients had a normal or non-obstructive spirometry pattern, so they were excluded from a COPD diagnostic. With regard to treatments, there was an overprescribing of inhaled steroids in patients from GOLD A and B groups, and also in patients with the called exacerbator phenotype (GesEPOC). CONCLUSION: Although there have been several published guidelines, management of COPD patients in real life should be improved.
Subject(s)
Pulmonary Disease, Chronic Obstructive , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Disease, Chronic Obstructive/therapyABSTRACT
BACKGROUND AND OBJECTIVES: To analyze the frequency of complications during laparoscopic gynecologic surgery and identify associated risk factors. METHODS: A descriptive observational study was performed between January 2000 and December 2012 and included all gynecologic laparoscopies performed at our center. Variables were recorded for patient characteristics, indication for surgery, length of hospital stay (in days), major and minor complications, and conversions to laparotomy. To identify risk factors and variables associated with complications, crude and adjusted odds ratios were calculated with unconditional logistic regression. RESULTS: Of all 2888 laparoscopies included, most were procedures of moderate difficulty (adnexal surgery) (54.2%). The overall frequency of major complications was 1.93%, and that of minor complications was 4.29%. The level of technical difficulty and existence of prior abdominal surgery were associated with a higher risk of major complications and conversions to laparotomy. CONCLUSION: Laparoscopic gynecologic surgery is associated with a low frequency of complications but is a procedure that is not without risk. Greater technical difficulty and prior surgery were factors associated with a higher frequency of complications.
Subject(s)
Genital Diseases, Female/surgery , Gynecologic Surgical Procedures/adverse effects , Laparoscopy/adverse effects , Postoperative Complications/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Gynecologic Surgical Procedures/methods , Humans , Incidence , Laparoscopy/methods , Length of Stay , Middle Aged , Risk Factors , Spain/epidemiology , Young AdultABSTRACT
Objetivos. Estimar los valores de las dimensiones de la calidad de vida mediante el cuestionario SF-12 en ancianos polimedicados con multimorbilidad e identificar variables asociadas. Material y métodos. Estudio transversal en una muestra de 393 enfermos elegidos en la población de mayores de 67 años que tomaban más de 5 medicamentos. El SF-12 se cumplimentó mediante entrevista personal en la consulta o en el domicilio del enfermo. Se calcularon medidas de tendencia central, dispersión y percentiles de las 8 dimensiones y de los componentes sumario físico y mental (CSF y CSM). Todos los enfermos por debajo del percentil 25 de los CSF y CSM fueron clasificados como enfermos con deterioro; mediante la regresión logística se determinaron qué variables se asocian con el deterioro de la calidad de vida. Resultados. Es una población con alta morbilidad. Los sujetos refieren puntuaciones muy bajas en las escalas salud general −media (DE): 25,7 (17,4)−; función física −32,6 (32,1)−; y CSF −37,8 (25,1)−. Las mujeres tienen en todas la escalas peor calidad de vida que los hombres. El sexo femenino, tener más 80 años, caídas frecuentes, dolor crónico, enfermedad cancerosa y depresión son las condiciones asociadas al deterioro de la calidad de vida relacionada con la salud (CVRS). Conclusión. Esta población tiene una mala CVRS sobre todo en las dimensiones físicas. El dolor crónico y la depresión junto con la edad y el sexo femenino son variables determinantes del deterioro de la CVRS (AU)
Objectives. To estimate the values of the quality of life dimensions using the SF-12 questionnaire in the elderly on polymedication and with multiple morbidities, and identify the variables associated with it. Material and methods. A cross-sectional study on a sample of 393 patients selected from the elderly population over 67 years and who took more than 5 drugs. The SF-12 was complemented by a personal interview in the clinic or in the home of the patient. Central tendency, dispersion, and the percentiles of the 8 dimensions were calculated, as well as the SF-36 physical and mental component summary measures (PCS and MCS). All patients below the 25th percentile of the PCS and MCS were classified as patients with a deterioration. Logistic regression was used to determine the variables that were associated with the deterioration in the quality of life. Results. It is a population with high morbidity. The subjects showed very low scores on the general health scales −mean (SD): 25.7 (17.4)−; physical function −32.6 (32.1)−; and PCS: [(37.8 (25.1)]. Women had a worse quality of life than men in all the scales. Female sex, being over 80 years, frequent falls, chronic pain, cancerous disease, and depression, are variables that determine the health-related quality of life (HR-QoL). Conclusion. This population has a poor HR-QoL, particularly in the physical dimensions. Chronic pain and depression, together with age and being female are variables that determine the deterioration in the HR-Q (AU)
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Quality of Life , Medication Therapy Management/organization & administration , Patient Medication Knowledge/methods , Patient Medication Knowledge/standards , Drug Therapy, Combination/methods , Drug Therapy, Combination , Drug Therapy, Combination , Surveys and Questionnaires , Health Services for the Aged/organization & administration , Morbidity Surveys , Cross-Sectional Studies/methods , Cross-Sectional Studies , Logistic Models , 28599 , Analysis of Variance , Drug Therapy, Combination/trendsABSTRACT
OBJECTIVES: To estimate the values of the quality of life dimensions using the SF-12 questionnaire in the elderly on polymedication and with multiple morbidities, and identify the variables associated with it. MATERIAL AND METHODS: A cross-sectional study on a sample of 393 patients selected from the elderly population over 67 years and who took more than 5 drugs. The SF-12 was complemented by a personal interview in the clinic or in the home of the patient. Central tendency, dispersion, and the percentiles of the 8 dimensions were calculated, as well as the SF-36 physical and mental component summary measures (PCS and MCS). All patients below the 25th percentile of the PCS and MCS were classified as patients with a deterioration. Logistic regression was used to determine the variables that were associated with the deterioration in the quality of life. RESULTS: It is a population with high morbidity. The subjects showed very low scores on the general health scales--mean (SD): 25.7 (17.4)-; physical function -32.6 (32.1)-; and PCS: [(37.8 (25.1)]. Women had a worse quality of life than men in all the scales. Female sex, being over 80 years, frequent falls, chronic pain, cancerous disease, and depression, are variables that determine the health-related quality of life (HR-QoL). CONCLUSION: This population has a poor HR-QoL, particularly in the physical dimensions. Chronic pain and depression, together with age and being female are variables that determine the deterioration in the HR-QoL.
Subject(s)
Polypharmacy , Quality of Life , Aged , Aged, 80 and over , Comorbidity , Cross-Sectional Studies , Female , Humans , Male , Surveys and QuestionnairesABSTRACT
Objetivo Medir e identificar las dimensiones y los determinantes de la calidad de vida relacionada con la salud (CVRS) en los enfermos con insuficiencia cardiaca crónica. Métodos Mediante un estudio transversal se midió la CVRS con los cuestionarios SF-36 y MLHFQ, en 544 enfermos con insuficiencia cardiaca crónica, clínicamente estables, de 97 médicos de atención primaria. Resultados La edad media de los enfermos es de 77,6 años (desviación estándar: 9,9), significativamente mayor en las mujeres. El 31,2% están en grado III-IV de la New York Heart Association (NYHA). El 88,6% tiene al menos otra enfermedad crónica. Las dimensiones físicas tienen peor puntuación que las emocionales en ambos cuestionarios. Tras ajustar por regresión múltiple, siete variables entran en alguno de los cinco modelos y explican entre un 22% y un 36% de la varianza. Conclusiones La CVRS en los pacientes con insuficiencia cardiaca crónica está alterada en todos los dominios. Ser mujer, estar en clase funcional de la NYHA III-IV, la presencia de otras afecciones tales como depresión o enfermedad osteoarticular, el ingreso hospitalario, el índice de masa corporal y la edad, se asocian con una peor percepción de la CVRS (AU)
Objective To measure and identify the dimensions and determinants of health-related quality of life (HRQoL) in patients with chronic heart failure. Methods We performed a cross-sectional study, in which HRQoL was measured with the short-form (SF)-36 and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) in 544 clinically-stable patients with chronic heart failure managed by 97 primary care physicians. Results The mean age of the patients was 77.6 years (SD: 9.9) and was significantly higher in women. A total of 31.2% were in New York Heart Association (NYHA) grade III-IV and 88.6% had at least one chronic condition. In both questionnaires, physical dimensions scored worse than emotional dimensions. After adjustment was made for multiple regression, seven variables entered into one of the five models and explained between 22% and 36% of the variance. Conclusions HRQoL in patients with chronic heart failure is impaired across all domains. Being female and being in NYHA functional class III-IV, as well as other factors such as depression, osteoarticular disease, hospital admission, body mass index and age, were associated with poorer self-perceived HRQoL (AU)
Subject(s)
Humans , Quality of Life , Heart Failure/psychology , Primary Health Care/statistics & numerical data , Comorbidity , Risk Factors , Depression/epidemiologyABSTRACT
OBJECTIVE: To measure and identify the dimensions and determinants of health-related quality of life (HRQoL) in patients with chronic heart failure. METHODS: We performed a cross-sectional study, in which HRQoL was measured with the short-form (SF)-36 and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) in 544 clinically-stable patients with chronic heart failure managed by 97 primary care physicians. RESULTS: The mean age of the patients was 77.6 years (SD: 9.9) and was significantly higher in women. A total of 31.2% were in New York Heart Association (NYHA) grade III-IV and 88.6% had at least one chronic condition. In both questionnaires, physical dimensions scored worse than emotional dimensions. After adjustment was made for multiple regression, seven variables entered into one of the five models and explained between 22% and 36% of the variance. CONCLUSIONS: HRQoL in patients with chronic heart failure is impaired across all domains. Being female and being in NYHA functional class III-IV, as well as other factors such as depression, osteoarticular disease, hospital admission, body mass index and age, were associated with poorer self-perceived HRQoL.