ABSTRACT
Medical therapy, including antianginal treatment, is the cornerstone in the management of stable ischemic heart disease (SIHD). However, it remains unclear whether combining antianginal agents provides benefits beyond monotherapy in terms of quality of life (QoL) and cardiovascular outcomes. We used data from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial, which compared cardiovascular and QoL outcomes in patients with SIHD and diabetes mellitus randomized to revascularization with intensive medical therapy or intensive medical therapy alone. We categorized patients into 3 groups: ≥2 versus 1 versus 0 antianginals. We compared patient characteristics, QoL metrics, and cardiovascular end points at baseline and at 5 years, creating a multivariable model to adjust for key clinical confounders. Of 2,368 patients, 348 patients (14.7%) were on 0 antianginals, 1,020 patients (43.1%) were on 1 antianginal, and 1,000 patients (42.2%) were on ≥2 antianginals at baseline. The most common antianginal class was ß blockers. At baseline, patients on 0 antianginals had better QoL metrics (self-health score, Duke activity status index, and energy rating) than patients on ≥2 antianginals. However, at the 1-year follow-up, patients taking only 1 antianginal showed greater QoL improvement than those taking 0 antianginal, without any incremental benefit in QoL metrics seen in patients taking ≥2 antianginal agents, even after adjusting for multiple covariates such as age, heart failure, diabetes control, and myocardial jeopardy index. Lastly, at the 5-year follow-up, after adjustment, there were no differences in all-cause mortality, major adverse cardiovascular events, or myocardial infarction between patients taking different numbers of antianginals. Adults on a single antianginal for SIHD and diabetes mellitus had similar or better improvements in QoL than those on 2 or more antianginal agents at 1 year of follow-up. These findings merit further research to better understand the impact of medical therapy intensity on QoL in patients with SIHD and associated co-morbidities.
Subject(s)
Cardiovascular Agents , Diabetes Mellitus, Type 2 , Myocardial Ischemia , Adult , Humans , Quality of Life , Coronary Artery Bypass , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/complications , Follow-Up Studies , Treatment Outcome , Myocardial Ischemia/complications , Angioplasty , Cardiovascular Agents/therapeutic useABSTRACT
OBJECTIVES: Our aim was to assess the value of nintedanib for non-idiopathic progressive fibrosing interstitial lung disease (non-IPF PF-ILD) and systemic sclerosis-associated ILD (SSc-ILD) in the Spanish context, using a multi-criteria decision analysis (MCDA). METHODS: Following an adaptation of the Evidence and Value: Impact on DEcision Making (EVIDEM) MCDA methodology, the estimated value of nintedanib was obtained by means of an additive linear model that combined individual weights (100-points distribution) of criteria with the individual scoring of nintedanib in each criterion for every indication, assigned by a multidisciplinary committee of twelve clinicians, patients, pharmacists, and decision-makers. To assess the reproducibility, an alternative weighting method was applied, as well as a re-test of weights and scores at a different moment of time. RESULTS: The experts committee recognized nintedanib as an intervention with a positive value contribution in comparison to placebo for the treatment of non-IPF PF-ILD (0.50 ± 0.16, on a scale from -1 to 1) and SSc-ILD (0.40 ± 0.12), diseases which were considered as very severe and with high unmet needs. The drug was perceived as a treatment that provides an added therapeutic benefit for patients (0.06-0.07), given its proven clinical efficacy (0.05-0.06), slight improvements in patient-reported outcomes (0.01-0.02), and similar safety profile than placebo (-0.04-0.00), which will likely be positioned as a recommended therapy in the next clinical practice guidelines updates. CONCLUSIONS: Under this increasingly used methodology, nintedanib has shown to provide a positive value estimate for non-IPF PF-ILD and SSc-ILD when compared to placebo in Spain.
Subject(s)
Lung Diseases, Interstitial , Decision Support Techniques , Disease Progression , Humans , Indoles/therapeutic use , Lung Diseases, Interstitial/drug therapy , Reproducibility of ResultsABSTRACT
EN: Stroke is the main cause of morbidity and mortality in Spain and in Galicia in particular. Tissue viability after stroke depends on the time taken to restore circulation. The widely dispersed and aging population of this region challenges efforts to provide equal care for patients with time-sensitive emergencies such as stroke. Two regional hospitals (Hospital do Salnés and Hospital do Barbanza) and the reference Hospital Clínico de Santiago launched a telestroke pilot program in 2011 in which patients whose treatment was guided at a distance were discharged with lower levels of stroke severity and mortality. That outcome was probably attributable to more rapid diagnosis. Given those preliminary results and the characteristics of the population, the centrally coordinated Galician Stroke Care Plan was launched in 2016 to provide a telemedicine service that connects all hospitals in the health system of Galicia. This paper summarizes the experience of developing and implementing the program.
ES: El ictus es la principal causa de morbimortalidad en Galicia y en España. Cuando se produce un ictus isquémico, la viabilidad del tejido está condicionada por el tiempo que transcurre hasta la revascularización. Galicia tiene una población envejecida y con gran dispersión. Ambos hechos suponen un reto para garantizar la equidad en la atención a pacientes con patologías tiempo-dependientes como el ictus. En el año 2011 se inició un proyecto piloto entre dos hospitales comarcales (Salnés y Barbanza) y el Hospital Clínico de Santiago. Se observó que los pacientes tratados a través del teleictus tendieron a una menor gravedad y mortalidad al alta, a expensas probablemente de una mayor agilidad en el proceso diagnóstico. Teniendo en cuenta estos resultados y las condiciones de la población gallega, en 2016 se inició el Plan Gallego de Atención al Ictus con la creación de un centro coordinador de atención al ictus y una red de telemedicina en todos los hospitales del Servicio Gallego de Salud. Este artículo resume la experiencia en el desarrollo e implantación de dicho plan.
Subject(s)
Interdisciplinary Communication , Stroke/drug therapy , Telemedicine , Thrombolytic Therapy , Acute Disease , Aged , Early Diagnosis , Female , Hospitals, University , Humans , Male , Middle Aged , Patient Acceptance of Health Care , Pilot Projects , Population Dynamics , Spain , Stroke/epidemiology , Telemedicine/organization & administration , Telemedicine/statistics & numerical data , Time-to-Treatment , Treatment OutcomeABSTRACT
El ictus es la principal causa de morbimortalidad en Galicia y en España. Cuando se produce un ictus isquémico, la viabilidad del tejido está condicionada por el tiempo que transcurre hasta la revascularización. Galicia tiene una población envejecida y con gran dispersión. Ambos hechos suponen un reto para garantizar la equidad en la atención a pacientes con patologías tiempo-dependientes como el ictus. En el año 2011 se inició un proyecto piloto entre dos hospitales comarcales (Salnés y Barbanza) y el Hospital Clínico de Santiago. Se observó que los pacientes tratados a través del teleictus tendieron a una menor gravedad y mortalidad al alta, a expensas probablemente de una mayor agilidad en el proceso diagnóstico. Teniendo en cuenta estos resultados y las condiciones de la población gallega, en 2016 se inició el Plan Gallego de Atención al Ictus con la creación de un centro coordinador de atención al ictus y una red de telemedicina en todos los hospitales del Servicio Gallego de Salud. Este artículo resume la experiencia en el desarrollo e implantación de dicho plan (AU)
Stroke is the main cause of morbidity and mortality in Spain and in Galicia in particular. Tissue viability after stroke depends on the time taken to restore circulation. The widely dispersed and aging population of this region challenges efforts to provide equal care for patients with time-sensitive emergencies such as stroke. Two regional hospitals (Hospital do Salnés and Hospital do Barbanza) and the reference Hospital Clínico de Santiago launched a telestroke pilot program in 2011 in which patients whose treatment was guided at a distance were discharged with lower levels of stroke severity and mortality. That outcome was probably attributable to more rapid diagnosis. Given those preliminary results and the characteristics of the population, the centrally coordinated Galician Stroke Care Plan was launched in 2016 to provide a telemedicine service that connects all hospitals in the health system of Galicia. This paper summarizes the experience of developing and implementing the program (AU)
Subject(s)
Humans , Stroke/epidemiology , Stroke/therapy , Emergency Medical Services/methods , Telemedicine/methods , Delivery of Health CareABSTRACT
Laminado cerâmico é uma opção de tratamento que pode ser indicada em casos de melhora na estética, fraturas traumáticas, má formação congênita de dentes e desgaste dental moderado. O objetivo deste trabalho foi restabelecer a estética dos dentes desgastados devido ao hábito parafuncional, devolver o guia canino através de restaurações cerâmicas e desprogramar o hábito parafuncional através da placa miorrelaxante. Os elementos 13 e 23 foram restaurados com laminados cerâmicos, e os elementos 14, 12, 11, 21, 22 e 24 foram restaurados com fragmentos cerâmicos. Todas as restaurações cerâmicas foram cimentadas com cimento resinoso Relyx Ultimate (3M Espe) associado ao uso de silano. Após a fi nalização da restauração, uma placa miorrelaxante foi confeccionada e ajustada em oclusão. Concluiu-se que o fragmento cerâmico confeccionado a partir do sistema CAD/CAM é uma sugestão rápida e efi ciente para o restabelecimento de facetas de desgaste.
Ceramic laminates are a treatment option indicated to improve aesthetics, traumatic fractures, congenital tooth malformation and moderate tooth wear. The aim of this case was to restore worn teeth due to parafunctional habits and return canine guidance through ceramic restorations deprogramming the parafunctional habit through a Michigan splint. The 13 and 23 units were restored with ceramic laminates and elements 14, 12, 11, 21, 22 and 24 were restored with ceramic fragments. All ceramic restorations were luted with Relyx Ultimate (3M Espe) cement and silane. After delivery, a Michigan splint was fabricated and adjusted into the patient´s mouth. Ceramic CAD/CAM fragments fabricated can be a fast and effi cient alternative to restore worn teeth.
