Análisis de efectividad y costes sanitarios de la inmunoprofilaxis con autovacuna MV140, vacuna MV140 y tratamiento antibiótico continuado en la prevención de las infecciones urinarias recurrentes / Effectiveness and health cost analysis between immunoprophylaxis with MV140 autovaccine, MV140 vaccine and continuous treatment with antibiotics to prevent recurrent urinary tract infections

Introducción El objetivo de este estudio fue comparar los resultados del tratamiento antibiótico continuado, la autovacuna MV140 y la vacuna bacteriana polivalente MV140 de cepas de colección en la prevención de ITU recurrentes no complicadas. Métodos Se analizaron prospectivamente 377 pacientes desde enero de 2017 hasta agosto de 2019 y se dividieron en 3 grupos según la profilaxis administrada. Grupo A (126): tratamiento antibiótico, Grupo B (126), autovacuna MV140; Grupo C (125), vacuna bacteriana polivalente MV140 a partir cepas seleccionadas. Las variables analizadas fueron: sexo, edad, menopausia, número de episodios de ITU al inicio y a los 3 y 6 meses de finalizar la profilaxis, costes sanitarios a lo largo del seguimiento a los 3 y 6 meses. Resultados A los 3 meses, los episodios de ITU se redujeron a 0-1 en el 65% del grupo A, en el 80,8% del grupo B y en el 81,7% del grupo C. A los 6 meses, se presentaron 0-1 episodios de ITU en el 44,4% del grupo A, en el 61,6% del grupo B y en el 74,6% del grupo C. En cuanto a los costes sanitarios a lo largo del seguimiento, a los 3 meses el grupo A registró 21.171,87 euros, el grupo B 20.763,73 euros y el grupo C 18.866,14 euros. A los 6 meses, los costes sanitarios fueron de 32.980,35 euros en el grupo A, de 28.133,42 euros en el grupo B y de 23.629,19 euros en el grupo C. Conclusiones La autovacuna MV140 y la vacuna bacteriana polivalente MV140 fueron más eficaces reduciendo el número de episodios de ITU a los 3 y 6 meses y con unos costes sanitarios menores durante el seguimiento, en comparación con la profilaxis antibiótica continuada (p < 0,05). La vacuna bacteriana polivalente MV140 de cepas seleccionadas fue más eficaz en la reducción del número de episodios de ITU con unos costes sanitarios menores que la autovacuna (AU)

Introduction The objective of this study was to compare the results on prevention of uncomplicated recurrent UTI between continuous use of antibiotics, MV140 autovaccine and MV140 polybacterial vaccine from collection strain. Methods 377 patients were prospectively analyzed from January 2017 to August 2019 and divided into 3 groups according to the prophylaxis. Group A (126): antibiotics, Group B (126): MV140 autovaccine, Group C (125): MV140 polybacterial vaccine from the collection strain. Variables analyzed were: gender, age, menopause, number of UTI at baseline and 3 and 6 months after the end of prophylaxis, health cost along follow-up at 3 and 6 months. Results At 3 months, group A had 0-1 UTI in 65%, group B had 0-1 UTI in 80.8% and group C in 81.7%. At 6 months, group A had 0-1 UTI in 44.4%, group B had 0-1 UTI in 61.6% and group C in 74.6%. Regarding health cost along follow-up, at 3 months group A had €21,171.87, group B had €20,763.73 and group C €18,866.14. At 6 months, health cost was €32,980.35 in group A, €28,133.42 in group B, and €23,629.19 in group C. Conclusions MV140 autovaccine and MV140 polybacterial vaccine were more efficient with lower number of UTI at 3 and 6 months and lower health cost along follow-up compared to continued prophylaxis with antibiotics (p < .05). Polybacterial MV140 vaccine from collection strain had higher effect to reduce the number of UTI and less health cost than autovaccine (AU)

Effectiveness and health cost analysis between immunoprophylaxis with MV140 autovaccine, MV140 vaccine and continuous treatment with antibiotics to prevent recurrent urinary tract infections.

INTRODUCTION: The objective of this study was to compare the results on prevention of uncomplicated recurrent UTI between continuous use of antibiotics, MV140 autovaccine and MV140 polybacterial vaccine from collection strain. METHODS: 377 patients were prospectively analyzed from January 2017 to August 2019 and divided into 3 groups according to the prophylaxis. Group A (126): antibiotics, Group B (126): MV140 autovaccine, Group C (125): MV140 polybacterial vaccine from the collection strain. Variables analyzed were: gender, age, menopause, number of UTI at baseline and 3 and 6 months after the end of prophylaxis, health cost along follow-up at 3 and 6 months. RESULTS: At 3 months, group A had 0-1 UTI in 65%, group B had 0-1 UTI in 80.8% and group C in 81.7%. At 6 months, group A had 0-1 UTI in 44.4%, group B had 0-1 UTI in 61.6% and group C in 74.6%. Regarding health cost along follow-up, at 3 months group A had euro21,171.87, group B had euro20,763.73 and group C euro18,866.14. At 6 months, health cost was euro32,980.35 in group A, euro28,133.42 in group B, and euro23,629.19 in group C. CONCLUSIONS: MV140 autovaccine and MV140 polybacterial vaccine were more efficient with lower number of UTI at 3 and 6 months and lower health cost along follow-up compared to continued prophylaxis with antibiotics (p < 0.05). Polybacterial MV140 vaccine from collection strain had higher effect to reduce the number of UTI and less health cost than autovaccine.

What still presents urgently to ENT during a pandemic? Experience of an ENT rapid access clinic during the coronavirus disease 2019 pandemic.

OBJECTIVES: This study sought to determine the conditions that still present to ENT despite government advice to avoid unnecessary travel. It also assessed the impact of social distancing on pathologies presenting to ENT and reviewed the usefulness of telephone consultations in semi-urgent presentations. METHOD: A retrospective review was conducted of 97 instances of patient care carried out in the rapid access ENT clinic at a large district general hospital. RESULTS: Otitis externa and foreign bodies represented 25 per cent and 13 per cent of consultations respectively. Tonsillitis and peritonsillar abscess were uncommon, representing 6 per cent of total consultations. Telephone appointments represented only 28 per cent of total consultations; however, they appeared to reduce the number of physical appointments required. CONCLUSION: Otitis externa and foreign bodies continue to be common during the pandemic. Social distancing measures reduced the number of tonsillitis and quinsy presentations. Telephone consultations are effective for certain urgent presentations to ENT, most noticeably nasal trauma and follow up of non-serious pathologies.

Global tuberculosis research and its future prospects.

Tuberculosis is the infectious disease that causes the most deaths each year in the world. Around 25% of the population is estimated to be infected with, Mycobacterium tuberculosis, the bacteria that gives rise to the disease, and more than one and a half million people die each year from this cause. A rigorous bibliometric analysis has been developed around tuberculosis disease, and the most remarkable results are presented in this paper. It is observed that interest in tuberculosis is growing, and the control of its spread has become one of the main health priorities in the world, with the United States, the United Kingdom, and India, leading the research in this area. On the other hand, it has been observed that there are two main health concerns around the tuberculosis: drug-resistant tuberculosis and co-infection with HIV. Finally, conclusions are offered, playing a frontline role in science policy decisions and research performance evaluations.

An improved simple method for the identification of Mycobacteria by MALDI-TOF MS (Matrix-Assisted Laser Desorption- Ionization mass spectrometry).

The aim of this study was to establish a simple method for the rapid identification of Mycobacteria species by MALDI-TOF (Matrix-Assisted Laser Desorption/Ionization-Time of Flight Mass spectrometry) using the Bruker MALDI-TOF Biotyper system (Bruker Daltonik, Bremen, Germany). A multicentre, prospective, and single blind study was performed in three European Hospitals, two Spanish and one UK hospital from May to August 2018. The BD BACTEC MGIT (Becton Dickinson, Berks, UK) liquid culture system was used in all three centres for the growth of Mycobacteria. When signal positive, tubes were removed from the analyser and in addition to standard laboratory procedures were subcultured on blood agar plates for MALDI-TOF analysis. Plates were incubated aerobically for 1 to 7 days at 37 °C and inspected every day. Once any growth was visible, it was transferred to the steel target plate, overlaid with 1 µl of neat formic acid and 1 µl HCCA matrix (alpha hydroxyl 4 cinnamic acid), and analysed in a Bruker Biotyper MALDI-TOF. Results given by MALDI-TOF were compared with the reference methods used for identification in the different centres. At two Spanish hospitals, identification by MALDI-TOF was only attempted on presumptive non-tuberculosis mycobacteria (NTM) and the results were initially compared with the results obtained by a commercial reverse hybridisation assay, GenoType CM/AS (Hain Lifescience, Tübingen, Germany). At the UK Hospital, identification of any presumptive mycobacteria was attempted and compared with the results obtained by whole genome sequencing (WGS). Overall in 142/167 (85%) of cases the identifications obtained were concordant; all Mycobacterium tuberculosis (MTB) isolates 43/43 (100%), 57/76 (75%) of the rapid growing nontuberculous mycobacteria (NTM), and 42/48 (85%) slow growing NTM tested were identified correctly. We report a new, easy, cheap and quick method for isolation and identification of Mycobacterium spp. without the need for additional steps or equipment and this method is in routine used in all three centres.

Aural fullness and transtympanic ventilation tubes in Ménière's disease: a scoping review.

BACKGROUND: Ménière's disease often presents with aural fullness, for reasons that are currently not well understood. Transtympanic ventilation tube insertion has been historically used for the management of this symptom, though the nature and mechanism of effectiveness is unclear. OBJECTIVE: To give an overview of the data available on the effects of ventilation tube insertion on aural fullness in Ménière's disease. METHODS: The databases PubMed, Embase, Medline, Scopus, Web of Science, Central and Google Scholar were searched to identify relevant records. Records were subsequently analysed and data extracted. RESULTS: Only two studies directly measured the effect of ventilation tube insertion on aural fullness, while three others measured it as a placebo to assess another treatment. Considerable heterogeneity was found amongst the studies, including conflicting conclusions. CONCLUSION: There is a paucity of evidence investigating the effect of grommet insertion on aural fullness in Ménière's disease. This work directs future research into this topic.

Robotic uterine-sparing vesicovaginal fistula repair.

INTRODUCTION AND HYPOTHESIS: The objective was to describe a technique for the robotic repair of complex vesicovaginal fistula (VVF) with uterine preservation. METHODS: From 2015 to 2017, two patients underwent the procedure. Following placement of the patient in the lithotomy position, catheterization of the fistulous tract and laparoscopic omental harvesting is performed. Then, the robotic system is docked. A transverse incision was made in the peritoneum above the uterus was made to provide access to the bladder, the uterus is mobilized, and a cystotomy is performed to identify the structures. Subsequently, the cystotomy is extended toward the fistulous tract, the plane between the organs is dissected to proceed with the vaginal closure, the vagina is closed, the omental flap is interposed, and the bladder is closed. RESULTS: Mean operative time (OT) was 219 min. Mean estimated blood loss (EBL) was 75 ml. One of the patients had an intraoperative cervix canal injury that was identified and repaired. The postoperative course was uneventful, and the mean length of hospital stay (LOS) was 1 day. A mean follow-up of 17 (±9.89) months showed no recurrence at cystoscopy or imaging evaluation. CONCLUSIONS: Uterine-sparing VVF repair is feasible and safe. More studies are needed to assess equivalence compared with other procedures.

Potential impacts of climate variability on dengue hemorrhagic fever in Honduras, 2010.

Climate change and variability are affecting human health and disease direct or indirectly through many mechanisms. Dengue is one of those diseases that is strongly influenced by climate variability; however its study in Central America has been poorly approached. In this study, we assessed potential associations between macroclimatic and microclimatic variation and dengue hemorrhagic fever (DHF) cases in the main hospital of Honduras during 2010. In this year, 3,353 cases of DHF were reported in the Hospital Escuela, Tegucigalpa. Climatic periods marked a difference of 158% in the mean incidence of cases, from El Niño weeks (-99% of cases below the mean incidence) to La Niña months (+59% of cases above it) (p<0.01). Linear regression showed significantly higher dengue incidence with lower values of Oceanic Niño Index (p=0.0097), higher rain probability (p=0.0149), accumulated rain (p=0.0443) and higher relative humidity (p=0.0292). At a multiple linear regression model using those variables, ONI values shown to be the most important and significant factor found to be associated with the monthly occurrence of DHF cases (r²=0.649; ßstandardized=-0.836; p=0.01). As has been shown herein, climate variability is an important element influencing the dengue epidemiology in Honduras. However, it is necessary to extend these studies in this and other countries in the Central America region, because these models can be applied for surveillance as well as for prediction of dengue.

Long-term quality of life in disadvantaged men with prostate cancer on androgen-deprivation therapy.

BACKGROUND: To explore the effects of androgen-deprivation therapy (ADT) on general, disease-specific and hormone-specific health-related quality of life (HRQOL) among minority men. METHODS: Men enrolled in a state-funded program, providing free prostate cancer treatment for underserved men, were recruited, if they had received at least 3 months of continuous ADT and/or other forms of primary treatment. HRQOL was assessed with validated measures including the RAND Medical Outcomes Study 12-item Health Short Form Survey (SF-12), the UCLA Prostate Cancer Index Survey and the Expanded Prostate Cancer Index Composite Survey. Repeated measures analysis was performed to evaluate the association between clinical and sociodemographic covariates with HRQOL. RESULTS: We enrolled 322 men, including 94 on ADT and 228 who received other forms of treatment. When controlling for patient characteristics, men receiving ADT had poorer outcomes relative to sexual function (P<0.01), sexual bother (P<0.01), hormonal function (P<0.01) and hormonal bother (P=0.02). ADT use was significantly associated with worsening sexual function (P<0.01) and sexual bother (P=0.01) over two years compared with non-ADT users. Analysis also demonstrated significant differences between whites, Hispanics and Others (African American (n=43, 16%), Asian (n=13, 5%), multiracial (n=1, 0.4%), Native American (n=1, 0.4%) and other (n=9, 3%)) relative to urinary bother (P=0.01), urinary function (P=0.01) and hormonal bother (P=0.03). ADT users had better urinary function and less bother than non-ADT users among the Other group, while the opposite was true for whites and Hispanics. For hormonal bother, ADT use was associated with worse outcomes across all three race/ethnicity groups; however, Hispanics were less bothered by their hormonal symptoms than whites or Others. CONCLUSION: Men of disadvantaged backgrounds on hormone therapy for prostate cancer experience declines in sexual and hormonal HRQOL. Whites and non-whites on ADT have significantly different HRQOL outcomes.

Potential impacts of climate variability on Dengue Hemorrhagic Fever in Honduras, 2010

Climate change and variability are affecting human health and disease direct or indirectly through many mechanisms. Dengue is one of those diseases that is strongly influenced by climate variability; however its study in Central America has been poorly approached. In this study, we assessed potential associations between macroclimatic and microclimatic variation and dengue hemorrhagic fever (DHF) cases in the main hospital of Honduras during 2010. In this year, 3,353 cases of DHF were reported in the Hospital Escuela, Tegucigalpa. Climatic periods marked a difference of 158% in the mean incidence of cases, from El Niño weeks (-99% of cases below the mean incidence) to La Niña months (+59% of cases above it) (p<0.01). Linear regression showed significantly higher dengue incidence with lower values of Oceanic Niño Index (p=0.0097), higher rain probability (p=0.0149), accumulated rain (p=0.0443) and higher relative humidity (p=0.0292). At a multiple linear regression model using those variables, ONI values shown to be the most important and significant factor found to be associated with the monthly occurrence of DHF cases (r2=0.649; βstandardized=–0.836; p=0.01). As has been shown herein, climate variability is an important element influencing the dengue epidemiology in Honduras. However, it is necessary to extend these studies in this and other countries in the Central America region, because these models can be applied for surveillance as well as for prediction of dengue.

Association between idiopathic achalasia and IL23R gene.

BACKGROUND: Idiopathic achalasia is a primary esophageal motor disorder of unknown etiology. Different evidences have been reported in support of achalasia as the result of an autoimmune and inflammatory process leading to neuronal cell loss. According to this, idiopathic achalasia has been significantly associated with specific alleles of the human leukocyte antigen system class II, although few reports studying association with other loci can be found in the literature. Recent studies have shown association of a non-synonymous polymorphism within the IL23R gene with different chronic inflammatory disorders, including Barrett's esophagus. The purpose of this study was to assess whether the IL23R coding variant Arg381Gln polymorphism is involved in susceptibility to idiopathic achalasia. METHODS: We performed a case-control study including 262 patients with idiopathic achalasia and 802 healthy subjects, all of them white Spaniards. Achalasia patients were diagnosed on the basis of clinical, radiographic, endoscopic, and manometric criteria. All samples were genotyped for the IL23R Arg381Gln polymorphism using TaqMan technology. KEY RESULTS: The minor allele of the Arg381Gln polymorphism was significantly increased in patients compared with healthy controls (OR = 1.46, 95% CI = 1.01-2.11, P = 0.036). This association seems to be specific to male patients with disease onset after 40 years (OR = 2.33, 95% CI = 1.29-4.16, P = 0.002). CONCLUSIONS & INFERENCES: Our results suggest a role of IL23R in idiopathic achalasia predisposition and extend the evidence of the general influence of this gene in autoimmune and inflammatory diseases.

Donepecilo bucodispersable: ¿están los cuidadores principales del paciente con enfermedad de Alzheimer más satisfechos que con la formulación tradicional de donepecilo? / Orally disintegrating donepezil: are the main caregivers of patients with alzheimer´s disease more satisfied with this formulation of donepezil than with the traditional one?

Objetivo. Conocer si los cuidadores principales de los pacientes con enfermedad de Alzheimer (EA) tratados condonepecilo están más satisfechos con la formulación bucodispersable que con los comprimidos convencionales. Pacientes ymétodos. Estudio multicéntrico y transversal que reclutó pacientes con posible/probable EA según el Manual diagnóstico y estadístico de los trastornos mentales, 4.ª edición (DSM-IV) o según el NINCDS-ADRDA en monoterapia con donepecilo, bucodispersable o en comprimidos. La satisfacción con el tratamiento se midió mediante el cuestionario genérico Treatment Satisfaction with Medicines Questionnaire (SATMED-Q) –rango: de 0, nada satisfecho, a 100, totalmente satisfecho–, de forma global y en seis dimensiones: tolerabilidad, eficacia, cuidado médico, comodidad de uso, impacto de la medicación y satisfaccióngeneral. Resultados. Se incluyeron 546 pacientes; el 64,8% eran mujeres, con una media de edad de 78,2 ± 6,5 años,22,5 ± 24,6 meses de evolución y una puntuación media en el test minimental de 18,5 ± 5; el 67,9% fue tratado con comprimidos, y el 32,1%, con bucodispersables. Tras corregir por test minimental y tiempo de tratamiento, los cuidadores de pacientes tratados con donepecilo bucodispersable mostraron puntuaciones más elevadas que con comprimidos en la puntuación total de satisfacción (74,5 ± 11,8 frente a 70,4 ± 12,3; p < 0,01), comodidad de uso (84,9 ± 16,4 frente a 79,8 ± 17,6; p = 0,0059) e impacto de la medicación en la vida diaria (50,2 ± 22,8 frente a 43,7 ± 25,5; p = 0,0006). El 91,6% de los cuidadores de pacientes tratados con bucodispersables declaró que le resultaba fácil tomar la medicación, frente al 82,9% con comprimidos (p = 0,023) (AU)

Aim. To know whether caregivers of Alzheimer’s disease (AD) patients on donepezil treatment are more satisfied with the orally disintegrating tablet (ODT) formulation than with the film-coated tablets. Patients and methods. Multicenter,cross-sectional study of patients with probably AD by DSM-IV or NINCDS-ADRDA criteria, on monotherapy with donepezil, ODT or film-coated tablets. Satisfaction with treatment was assessed by the caregiver self-administered generic TreatmentSatisfaction with Medicines Questionnaire (SATMED-Q) –range: 0, no satisfaction, to 100, maximal satisfaction–, total andin six dimensions: undesirable effects, efficacy, medical care, medication ease and convenience, medication impact on daily activities, and overall satisfaction. Results. 546 patients were enrolled (9,6% institutionalized); 64,8% women; 78,2 ± 6,5 years of age; disease evolution of 22.5 ± 24.6 months, Minimental State Examination (MMSE) mean score: 18,5 ± 5; 67.9%on film-coated tablets and 32.1% on ODT. After adjusting by MMSE and time of treatment, caregivers of patients on ODT showed significantly higher SATMED-Q total score (74.5 ± 11.8 vs. 70.4 ± 12.3; p < 0.0004) and medication ease and convenience (84.9 ± 16.4 vs. 79.8 ± 17.6; p = 0.0059), impact of medication on daily activities (50.2 ± 22.8 vs. 43.7 ± 25.5;p = 0.0006) and satisfaction with medical care (79.4 ± 19.5 vs. 75.6 ± 21.8; p = 0.04894) scores. 91.6% of caregivers of patients on ODT (versus 82.9% of those on film-coated tablets; p = 0.023) stated that taking the medication was easy for theirrelatives. Conclusions. Results show that caregivers of AD patients on donepezil treatment are more satisfied with ODT versus film-coated tablets, especially due to its better ease of use (AU)

[Orally disintegrating donepezil: are the main caregivers of patients with Alzheimer's disease more satisfied with this formulation of donepezil than with the traditional one?]. / Donepecilo bucodispersable: están los cuidadores principalesdel paciente con enfermedad de Alzheimer más satisfechosque con la formulación tradicional de donepecilo?

AIM: To know whether caregivers of Alzheimer's disease (AD) patients on donepezil treatment are more satisfied with the orally disintegrating tablet (ODT) formulation than with the film-coated tablets. PATIENTS AND METHODS: Multicenter, cross-sectional study of patients with probably AD by DSM-IV or NINCDS-ADRDA criteria, on monotherapy with donepezil, ODT or film-coated tablets. Satisfaction with treatment was assessed by the caregiver self-administered generic Treatment Satisfaction with Medicines Questionnaire (SATMED-Q) -range: 0, no satisfaction, to 100, maximal satisfaction-, total and in six dimensions: undesirable effects, efficacy, medical care, medication ease and convenience, medication impact on daily activities, and overall satisfaction. RESULTS: 546 patients were enrolled (9,6% institutionalized); 64,8% women; 78,2 +/- 6,5 years of age; disease evolution of 22.5 +/- 24.6 months, Minimental State Examination (MMSE) mean score: 18,5 +/- 5; 67.9% on film-coated tablets and 32.1% on ODT. After adjusting by MMSE and time of treatment, caregivers of patients on ODT showed significantly higher SATMED-Q total score (74.5 +/- 11.8 vs. 70.4 +/- 12.3; p lower than 0.0004) and medication ease and convenience (84.9 +/- 16.4 vs. 79.8 +/- 17.6; p = 0.0059), impact of medication on daily activities (50.2 +/- 22.8 vs. 43.7 +/- 25.5; p = 0.0006) and satisfaction with medical care (79.4 +/- 19.5 vs. 75.6 +/- 21.8; p = 0.04894) scores. 91.6% of caregivers of patients on ODT (versus 82.9% of those on film-coated tablets; p = 0.023) stated that taking the medication was easy for their relatives. CONCLUSIONS: Results show that caregivers of AD patients on donepezil treatment are more satisfied with ODT versus film-coated tablets, especially due to its better ease of use.

Current treatments of Alzheimer disease: are main caregivers satisfied with the drug treatments received by their patients?

BACKGROUND/AIMS: A full comparison of the satisfaction with treatment using the current Alzheimer's disease (AD) therapies from the perspective of caregivers has not yet been done. The aim of this study was thus to find out the degree of satisfaction with the main available drug treatments in monotherapy for AD from this point of view. METHODS: A cross-sectional, multicentre study of patients with possible/probable AD according to DSM-IV/NINCDS-ADRDA criteria, on monotherapy with donepezil, galantamine, rivastigmine or memantine, was carried out. Treatment satisfaction was measured by a caregiver proxy-administration of the generic SATMED-Q questionnaire [range: 0 (not satisfied at all) to 100 (totally satisfied)], overall and in 6 domains: tolerability, efficacy, medical care, ease and convenience, impact on daily activities and overall satisfaction. RESULTS: A total of 829 patients were included: 63.3% women, aged 78.2 +/- 6.8 years; 546 (67.3%) on donepezil, 106 (13.1%) on rivastigmine, 99 (12.2%) on galantamine and 60 (7.4%) on memantine. SATMED-Q scores p values were adjusted by MMSE and treatment duration. Caregivers of patients on donepezil showed significantly higher SATMED-Q total (71.8 +/- 12.3; p < 0.05) and overall satisfaction domain scores (81.6 +/- 18.4; p < 0.01) than those of patients on any other drugs, as well as significantly higher ease and convenience of use domain (81.5 +/- 17.4; p < 0.01) and undesirable effects domain (96.0 +/- 12.9; p < 0.05) scores than those of rivastigmine- and galantamine-treated patients. Of the caregivers of donepezil-treated patients, 76.7% were satisfied with treatment versus 68.7, 61.4 and 46.7% of those caregivers whose patients were treated with galantamine, rivastigmine and memantine, respectively (p = 0.0002). CONCLUSION: Caregivers of AD patients undergoing donepezil monotherapy seem to be more satisfied with treatment than those of patients receiving the other usual AD treatments in this study, particularly due to the ease and convenience of use of this drug. The higher level of satisfaction of these caregivers could be explained by the fact that, within the donepezil group, a high percentage of patients were treated with orally disintegrating tablets, which are easier for the patient to swallow.