Preferencias por los tratamientos anticoagulantes orales para la prevención a medio y largo plazo del ictus en la fibrilación auricular no valvular / Preferences for oral anticoagulant treatment in the medium and long term prevention of stroke in non valvular atrial fibrillation

Introducción. Un 40% de los pacientes con anticoagulación oral no iniciaría el tratamiento con antagonistas de la vitamina K por la necesidad de controles periódicos y sus interferencias con la dieta y medicación concomitante. Objetivo. Analizar las preferencias de los pacientes con fibrilación auricular no valvular por anticoagulantes orales (AO) para la prevención del ictus. Pacientes y métodos. Estudio observacional, transversal, multicéntrico, de preferencias y disponibilidad a pagar: se definieron los atributos de los AO mediante revisión de la bibliografía, grupos focales y entrevistas semiestructuradas con médicos y pacientes. Posteriormente, se definieron escenarios que los pacientes ordenaron según sus preferencias. Se analizaron los datos de la muestra total y por conglomerados agrupados por sus preferencias. Resultados. Se definieron ocho escenarios basados en cinco atributos: eficacia, seguridad, dosis fija, necesidad de controles de la coagulación, e interacciones con la dieta y medicación. Se entrevistó a 295 pacientes ambulatorios (edad media: 71,76 ± 9,81 años) que recibían AO. El atributo preferido fue el ‘menor número de embolias/año’ (importancia: 30,15%), seguido de ‘dosis fija del AO’ (25,45%) y ‘menor número de hemorragias intracraneales anuales’ (21,57%). En la muestra se identificaron tres segmentos de población con preferencias diferentes. La máxima disponibilidad a pagar (media) por un AO fue 66,76 ± 54,64 euros mensuales. Conclusiones. Eficacia, dosis fija y seguridad son los atributos de los AO más valorados por los pacientes con fibrilación auricular no valvular. Estas preferencias deberían considerarse al instaurar o cambiar el tratamiento con AO para mejorar el cumplimiento y prevención en pacientes (AU)

Introduction. About 40% of patients who receive oral anticoagulation would not start treatment with vitamin K antagonists due to the regular control they require and their interference with the diet and other concomitant medications. Aim. To analyze the preferences of patients with non valvular atrial fibrillation for oral anticoagulants (OAs) for the stroke prevention. Patients and methods. Observational, multicentric study on preferences and maximum willingness to pay based on conjoint analysis: literature review, focus groups and semi-structured interviews with physicians and patients (n = 295) to define the attributes of OAs and their levels. Definition of scenarios that patients ordered according to their preferences. Clusters analysis to identify population groups by their preferences. Results. Eight scenarios were defined based on five attributes: efficacy, security, a fixed dose, need for coagulation controls and interactions with diet and medication. The most preferred attribute was the smaller number of embolisms in a year (importance: 30.15%) followed by the fixed dose of the OA (25.45%) and the smaller number of intracranial hemorrhage in a year (21.57%). Three clusters population were identified. The maximum amount patients’ were willingness to pay for the OA was 66.76 ± 54.64 euros (mean) per month. Conclusions. Efficacy and a fixed dose are the attributes of OA most valued by non valvular atrial fibrillation patients. There are groups of patients who differ in their preferences. This differences should be taken into account when deciding instauration or change on the OA treatment to ameliorate the accomplishment and prevention in this patients (AU)

[Preferences for oral anticoagulant treatment in the medium and long term prevention of stroke in non valvular atrial fibrillation]. / Preferencias por los tratamientos anticoagulantes orales para la prevencion a medio y largo plazo del ictus en la fibrilacion auricular no valvular.

INTRODUCTION: About 40% of patients who receive oral anticoagulation would not start treatment with vitamin K antagonists due to the regular control they require and their interference with the diet and other concomitant medications. AIM: To analyze the preferences of patients with non valvular atrial fibrillation for oral anticoagulants (OAs) for the stroke prevention. PATIENTS AND METHODS: Observational, multicentric study on preferences and maximum willingness to pay based on conjoint analysis: literature review, focus groups and semi-structured interviews with physicians and patients (n = 295) to define the attributes of OAs and their levels. Definition of scenarios that patients ordered according to their preferences. Clusters analysis to identify population groups by their preferences. RESULTS: Eight scenarios were defined based on five attributes: efficacy, security, a fixed dose, need for coagulation controls and interactions with diet and medication. The most preferred attribute was the smaller number of embolisms in a year (importance: 30.15%) followed by the fixed dose of the OA (25.45%) and the smaller number of intracranial hemorrhage in a year (21.57%). Three clusters population were identified. The maximum amount patients' were willingness to pay for the OA was 66.76 ± 54.64 euros (mean) per month. CONCLUSIONS: Efficacy and a fixed dose are the attributes of OA most valued by non valvular atrial fibrillation patients. There are groups of patients who differ in their preferences. This differences should be taken into account when deciding instauration or change on the OA treatment to ameliorate the accomplishment and prevention in this patients.

[Epidemiology of invasive candidiasis in pediatric and adult populations]. / Epidemiología de las candidiasis invasoras en población pediátrica y adulta.

BACKGROUND: Invasive candidiasis (IC) is the most frequent fungal disease in children and adults. AIMS: To critically review and update the current epidemiology of Candida spp. disease in neonates, children and adults (critically ill patients and in oncohematologic patients and in solid organ transplant recipients). METHODS: We searched the PubMed/Medline, discussing the current data. RESULTS AND CONCLUSIONS: IC is associated with high attributable morbimortality and increased healthcare costs. In the last decades the incidence of invasive Candida spp. disease has increased in critically ill patients, has decreased in oncohematologic patients, although currently the involvement of non-albicans Candida species in the etiology of this disease is increasing steadily.

Epidemiología de las candidiasis invasoras en población pediátrica y adulta / Epidemiology of invasive candidiasis in pediatric and adult populations

Antecedentes: La candidiasis invasora (CI) es la enfermedad fúngica oportunista más frecuente, tanto en niños como en adultos. Objetivos: Se presenta una revisión actualizada sobre los aspectos epidemiológicos en neonatos, niños y adultos ingresados en unidades de cuidados intensivos, así como en pacientes oncohematológicos y receptores de trasplantes de órgano sólido. Métodos: Se ha realizado una búsqueda bibliográfica en la base de datos PubMed/Medline. Se presenta una revisión actualizada. Resultados y conclusiones: La CI se asocia a una elevada morbimortalidad y costes económicos. En las últimas décadas, la enfermedad invasora debida a Candida spp. ha aumentado de forma significativa en pacientes críticos, ha disminuido en pacientes oncohematológicos, aunque en todas las distintas subpoblaciones son más prevalentes las especies de Candida diferentes de C. albicans (AU)

Background: Invasive candidiasis (IC) is the most frequent fungal disease in children and adults. Aims: To critically review and update the current epidemiology of Candida spp. disease in neonates, children and adults (critically ill patients and in oncohematologic patients and in solid organ transplant recipients). Methods: We searched the PubMed/Medline, discussing the current data. Results and conclusions: IC is associated with high attributable morbimortality and increased healthcare costs. In the last decades the incidence of invasive Candida spp. disease has increased in critically ill patients, has decreased in oncohematologic patients, although currently the involvement of non-albicans Candida species in the etiology of this disease is increasing steadily (AU)

Nosocomial spread of linezolid-resistant Staphylococcus haemolyticus infections in an intensive care unit.

This report documents the nosocomial spread for an 18-month period of a single clone of linezolid- and teicoplanin-resistant Staphylococcus haemolyticus associated primarily with catheter-related bacteremia in intensive care unit patients. All linezolid-resistant isolates had the same G2576T mutation in at least 1 copy of the 23S rRNA gene.