[Clinical profile and satisfaction with anticoagulated treatment in patients with non-valvular atrial fibrillation attended in Internal Medicine and Neurology departments of Spain]. / Perfil clinico y satisfaccion con el tratamiento anticoagulante en pacientes con fibrilacion auricular no valvular atendidos en consultas de medicina interna y neurologia de España.

AIM: To determine the clinical profile, management of anticoagulant treatment and satisfaction related to anticoagulation in outpatients with nonvalvular atrial fibrillation attended in Neurology or Internal Medicine departments of Spain. PATIENTS AND METHODS: Cross-sectional and multicenter study, in which 1,337 outpatients were included. Patients fulfilled ACTS, SAT-Q and EQ-5D questionnaires. RESULTS: 865 patients (64.7%) were recruited from Neurology department and 472 (35.3%) from Internal Medicine department. Those patients attended in Internal Medicine department were older and had more frequently hypertension, diabetes, heart failure, renal insufficiency and peripheral artery disease. Those patients attended in Neurology department had more commonly prior stroke. Overall, CHADS2 score was 3.2 ± 1.3, CHA2DS2-Vasc 4.8 ± 1.5 and HAS-BLED 2.0 ± 0.9. All scores were higher in those patients attended in Neurology department. Globally, 56.1% of patients were taking vitamin K antagonists, more commonly in Internal Medicine department. The adequate percent of time in therapeutic range was 47% (Rosendaal), without significant differences between groups. Satisfaction with oral anticoagulation was high in both groups, but higher in those attended in Neurology department, and higher in those individuals taking direct oral anticoagulants compared with vitamin K antagonists. CONCLUSIONS: Although there were some differences in the clinical profile of patients with atrial fibrillation attended in Neurology or Internal Medicine departments, all of them had many comorbidities and a high thromboembolic risk. Despite INR control was poor, the most common oral anticoagulant used were vitamin K antagonists. Satisfaction related to oral anticoagulation was high.

TITLE: Perfil clinico y satisfaccion con el tratamiento anticoagulante en pacientes con fibrilacion auricular no valvular atendidos en consultas de medicina interna y neurologia de España.Objetivo. Determinar el perfil clinico, el manejo del tratamiento anticoagulante y la satisfaccion relacionada con la anticoagulacion en pacientes con fibrilacion auricular no valvular atendidos en consultas de neurologia o medicina interna de España. Pacientes y metodos. Estudio prospectivo, transversal y multicentrico en el que se incluyo a 1.337 pacientes, que completaron los cuestionarios Anti-Clot Treatment Scale, Self-Assessment of Treatment Questionnaire y EuroQol-5 dimensions. Resultados. 865 pacientes (64,7%) provenian de consultas de neurologia, y 472 (35,3%), de medicina interna. Los atendidos en medicina interna eran mayores, tenian mas hipertension, diabetes, insuficiencia cardiaca, insuficiencia renal y arteriopatia periferica. Los pacientes atendidos en neurologia tenian mas antecedentes de ictus. Globalmente, la escala CHADS2 fue 3,2 ± 1,3; CHA2DS2Vasc, 4,8 ± 1,5, y HAS-BLED, 2,0 ± 0,9, y las puntuaciones mas altas fueron en neurologia. El 56,1% tomaba antagonistas de la vitamina K, lo que era mas comun en medicina interna. El porcentaje de tiempo en rango terapeutico adecuado fue del 47% (Rosendaal), sin diferencias entre los grupos. La satisfaccion con el tratamiento anticoagulante oral fue elevada en ambos grupos, aunque mayor en los sujetos atendidos en neurologia, y mayor con los anticoagulantes orales de accion directa que con los antagonistas de la vitamina K. Conclusiones. Aunque existieron ciertas diferencias en el perfil clinico de los pacientes con fibrilacion auricular atendidos en neurologia o medicina interna, todos presentaban multiples comorbilidades y un riesgo tromboembolico elevado. A pesar de que el control del indice internacional normalizado fue pobre, el anticoagulante oral mas empleado fueron los antagonistas de la vitamina K. La satisfaccion con el tratamiento anticoagulante oral fue alta.

Changing trends in hospitalization rates associated with psychosis: Spain, 1980-2009.

PURPOSE: To analyze the prevalence of hospitalization attributable to psychosis in Spain over the last three decades. METHODS: Longitudinal analysis (1980-2009) of age-adjusted hospital discharges rates associated with psychosis (ICD9 290-8) in all Spanish hospitals. DATA SOURCE: Spanish Hospital Morbidity Survey. RESULTS: The hospitalization rate associated with psychotic episodes had been gradually increasing since 1980 until 2004; an abrupt turnaround observed in 2004 marks the beginning of a steady decline in the rate. The turning point described is not observed for each of the psychotic diagnoses separately analyzed. However, it is clearly seen when data are grouped in diagnosis-related groups (organic-psychosis, functional psychosis and substance-induced psychosis) since the time course of the diseases within the major diagnostic groups are interrelated as evidenced by shared turning points which collectively display a common time course pattern. Main hospital indicators and antipsychotic drug prescriptions were analyzed for any possible turning point in mid-2000s. Psychiatric hospital beds and length of stays remained stable by 2004; the hospitalizations associated with non-psychotic psychiatric pathologies show no turning point in 2004. However, an abrupt change on antipsychotic drug prescriptions is precisely observed in 2004. CONCLUSIONS: After decades of linear growth, hospitalizations for psychotic patients begin to decline in 2004, coinciding with the start of last generation atypical antipsychotic drug consumption in Spain. Some of the psychotic diagnostic rates evolve in an interrelated manner which calls into question the diagnosis and nosological boundaries between some of these pathologies.

Effectiveness and safety of glimepiride and iDPP4, associated with metformin in second line pharmacotherapy of type 2 diabetes mellitus: systematic review and meta-analysis.

OBJECTIVE: Our review analyses the studies that have specifically compared the association iDPP4/metformin with glimepiride/metformin, both in second line pharmacotherapy of type 2 diabetes mellitus (DM2). METHODS: Systematic literature review with a meta-analysis of clinical trials comparing glimepiride with any iDPP4, both used together with metformin as a second line treatment of DM2. The effectiveness variables used were as follows: %HbA1c variation, fasting plasma glucose variation, patients achieving the therapeutic objective of HbA1c <7%, treatment dropouts due to lack of effectiveness and rescue treatments needed. The safety variables included were as follows: weight variation at the end of treatment; presentation of any type of adverse event; presentation of serious adverse events; patients who experienced any type of hypoglycaemia; patients who experienced severe hypoglycaemia; treatments suspended due to adverse effects; and deaths for any reason. RESULTS: Four studies met the inclusion criteria. The group treated with glimepiride showed better results in all effectiveness variables. Regarding safety variables, the main differences observed were in the greater number of cases with hypoglycaemia in the group treated with glimepiride, and the serious adverse events or treatment discontinuations due to these which occurred in slightly over 2% more cases in this group compared to the iDPP4 group. The remaining adverse events, including mortality, did not show any differences between both groups. The variation in the weight difference between groups (2.1 kg) is not considered clinically relevant. CONCLUSIONS: A greater effectiveness is seen in the glimepiride/metformin association, which should not be diminished by slight differences in adverse effects, with absence of severe hypoglycaemia in over 98% of patients under treatment. The association of glimepiride/metformin, both due to cost as well as effectiveness and safety, may be the preferential treatment for most DM2 patients, and it offers a potential advantage in refractory hyperglycemic populations, tolerant to treatment.

Trends on schizophrenia admissions during the deinstitutionalisation process in Spain (1980-2004).

BACKGROUND: The deinstitutionalisation reform in Spain started after 1980 with the aim of reducing the need for hospitalisation, length of stay and the number of psychiatric hospital beds, as well as fostering psychiatric patient's involvement in the community. The aim of this study was to review how this reform process has affected the management of schizophrenic patients from 1980 to 2004. METHODS: Longitudinal (1980-2004) study describing variables related to hospital morbidity in schizophrenia patients. RESULTS: Hospital admission rate has gradually increased from 1980 to 2004 from 3.71 admissions per 10,000 inhabitants to 5.89, respectively. Considering the type of admission, emergency or elective, whilst the latter has slightly decreased from 2.24 in 1980 to 1.72 in 2004, the first has almost tripled from 1.47 to 4.17. The point-prevalence of schizophrenic patients receiving inpatient treatment each year has decreased 78% in this period. Length of stay, in days per admission episode, has also decreased from 148 days in 1980 to 35 days in 2004. CONCLUSION: One of the main impacts of the psychiatric health care reform in Spain has been the considerable reduction in hospital capacity devoted to schizophrenic patients, based on the significant decrease in point-prevalence. Thus, it seems relevant to design new studies to quantify the resource reallocation to other areas of care, such as pharmacological treatment and community services.

Poor bisphosphonate adherence for treatment of osteoporosis increases fracture risk: systematic review and meta-analysis.

UNLABELLED: Systematic review of adherence to bisphosphonates for the treatment of osteoporosis finds suboptimal levels of persistence and compliance. Poor bisphosphonate compliance increases fracture risk. INTRODUCTION: The objectives of the study were to measure the persistence and compliance with bisphosphonates for the treatment of osteoporotic patients, and to estimate the influence of compliance on fracture risk. METHODS: A systematic review of bisphosphonate adherence in clinical practise provided new evidence to perform a meta-analysis of the means of bisphosphonate persistence and compliance, with a subsequent meta-analysis of fracture risk comparing poorly versus highly compliant patients. RESULTS: Fifteen articles, totalling 704,134 patients, met our inclusion criteria. Most of the patients were postmenopausal women treated with bisphosphonates. The 3.95% of the patients received hormone replacement therapy, but the rest received bisphosphonates. The meta-analysis of five articles totalling 236,540 patients, who were followed for 1 year, provided a pooled persistence mean of 184.09 days. The meta-analysis of five articles, totalling 234,737 patients, who were also followed for 1 year, provided a pooled medication possession ratio mean of 66.93%. The meta-analysis of six articles, totalling 171,063 patients, who were followed for varying periods of time between 1 and 2.5 years, provided a pooled 46% increased fracture risk in non-compliant patients versus compliant patients. The increased fracture risk was lower for non-vertebral (16%) and hip (28%) than for clinical vertebral fractures (43%). CONCLUSIONS: Persistence and compliance are suboptimal for postmenopausal women undergoing bisphosphonate therapy for osteoporosis. The clinical consequence of this low compliance is an increased risk of fracture, which is lower for non-vertebral than for clinical vertebral fractures.

Hospitalised osteoporotic vertebral fractures in Spain: analysis of the national hospital discharge registry.

UNLABELLED: This population-based study reveals clinical and epidemiologic characteristics of hospitalised osteoporosis-related vertebral fractures and indicates an association with a substantial hospital burden in Spain. These data provide a basis for assessing the impact of these fractures on the Spanish health-care system and to estimate future care requirements. INTRODUCTION: Vertebral fractures (VF) are recognised as the most frequent complication of osteoporosis. Our objective was to determine the clinico-epidemiological characteristics and health-care burden of hospitalised VF in Spain. METHOD: From the 2002 National Hospital Discharge Register, records for all osteoporosis-related VF in the Spanish population aged >or=30 years and over were retrieved. Diagnostic categories included the ICD-9-CM codes 805 and 733.xx. Population data were drawn from the National Statistics Institute. RESULTS: In total, 7,100 records were eligible for analysis. According to Deyo-adapted Charlson index, 62% of cases had no associated comorbidity. VF were the cause of hospitalisation in 52% of cases. Overall in-hospital mortality was 3.5%. Men had higher adjusted mortality than women. Mean hospital stay was 11.4+/-0.2 days. Identified cases amounted to a hospitalisation rate of 2.76 cases per 10,000 population aged >or=30 years. Direct inpatient hospital costs exceeded 41 million euros and accounted for 0.078% of Spanish expenditure on hospitalisations and specialised care in 2002. CONCLUSIONS: The national discharge database reveals epidemiological features of hospitalised osteoporosis-attributable VF and indicates an association with a substantial hospital burden in Spain. Our data provide a basis for assessing the impact of these fractures on the Spanish health-care system and to estimate future care requirements.

Síndrome pospolio: revisión de sus características clínicas y tratamiento / Post-polio syndrome: a review of its clinical characteristics and treatment

Introducción. El síndrome pospolio (SPP) se reconocecomo un síndrome clínico causante del deterioro funcional tardío yprogresivo que sufren los supervivientes de un episodio de poliomielitisaguda. La importancia del SPP se reconoce por sectores cadavez más amplios de la población y las esferas sanitarias; sin embargo,tanto su epidemiología como sus características clínicas y sutratamiento están escasamente documentados. Objetivo. Revisar laevidencia científica actualmente disponible sobre las manifestacionesclínicas, factores de riesgo, prevalencia, diagnóstico y recomendacionesde tratamiento del SPP. Desarrollo. Revisión de la literaturamédica en la base de datos MEDLINE. La búsqueda se ha restringidoa estudios en humanos publicados de forma completa en inglésy/o castellano hasta diciembre de 2004. Conclusiones. El SPP se reconocecomo un síndrome neurológico específico que aparece variasdécadas después del episodio agudo de polio, agrava las secuelasmotoras ya presentes en dichos pacientes y reduce su capacidadfuncional hasta afectar las actividades de la vida diaria. Su etiologíaaún no ha sido claramente identificada y constituye un procesode difícil diagnóstico y manejo para el cual aún no existe un tratamientoespecífico. Sin embargo, el impacto psicológico y funcionalque supone en los afectados y la posibilidad de una notable mejoríasintomática exigen un esfuerzo de identificación por parte de losprofesionales de manera que se reconozcan las necesidades clínicasque dicho síndrome impone y se reduzcan las barreras asistencialesexistentes en la actualidad

Introduction. Post-polio syndrome (PPS) is recognised as a clinical syndrome that causes the late, progressivefunctional impairment suffered by survivors of an acute episode of poliomyelitis. The importance of PPS is acknowledged byincreasingly wider sectors of the population and health care sectors; nevertheless, few reports have been published about itsepidemiology or its clinical characteristics and treatment. Aim. To review the current scientific evidence available on theclinical manifestations, risk factors, prevalence, diagnosis and recommendations for treatment of PPS. Development. Weconducted a review of the medical literature in the MEDLINE database. The search was restricted to studies conducted inhumans that had been published as complete works in English and/or Spanish up to December 2004. Conclusions. PPS isrecognised as being a specific neurological syndrome that appears several decades after the acute episode of polio; itexacerbates the motor sequelae already present in these patients and reduces their functional capacity to a point where it affectstheir activities of daily living. Its causation has still not been clearly identified and it constitutes a process that is difficult todiagnose and manage. In addition, no specific treatment has been developed for this condition to date. Nevertheless, thepsychological and functional impact it has on its victims and the possibility of bringing about a significant improvement in thesymptoms call for a greater effort by professionals to identify the clinical needs imposed by the syndrome and to break downsome of the health care barriers that currently exist

[Post-polio syndrome: a review of its clinical characteristics and treatment]. / Sindrome pospolio: revision de sus caracteristicas clinicas y tratamiento.

INTRODUCTION: Post-polio syndrome (PPS) is recognised as a clinical syndrome that causes the late, progressive functional impairment suffered by survivors of an acute episode of poliomyelitis. The importance of PPS is acknowledged by increasingly wider sectors of the population and health care sectors; nevertheless, few reports have been published about its epidemiology or its clinical characteristics and treatment. AIM: To review the current scientific evidence available on the clinical manifestations, risk factors, prevalence, diagnosis and recommendations for treatment of PPS. DEVELOPMENT: We conducted a review of the medical literature in the MEDLINE database. The search was restricted to studies conducted in humans that had been published as complete works in English and/or Spanish up to December 2004. CONCLUSIONS: PPS is recognised as being a specific neurological syndrome that appears several decades after the acute episode of polio; it exacerbates the motor sequelae already present in these patients and reduces their functional capacity to a point where it affects their activities of daily living. Its causation has still not been clearly identified and it constitutes a process that is difficult to diagnose and manage. In addition, no specific treatment has been developed for this condition to date. Nevertheless, the psychological and functional impact it has on its victims and the possibility of bringing about a significant improvement in the symptoms call for a greater effort by professionals to identify the clinical needs imposed by the syndrome and to break down some of the health care barriers that currently exist.

Efficacy of advanced dressings in the treatment of pressure ulcers: a systematic review.

A meta-analysis of published research enabled dressing efficacy to be estimated. Comparisons showed greater efficacy of hydrocolloid dressings but failed to confirm advantages of other advanced dressings compared with conventional ones.

Evaluación de las tecnologías sanitarias y ordenación de las prestaciones en los sistemas sociales avanzados / Evaluation of health technologies and benefits entitlement in advanced social systems

El presente trabajo parte de la consideración de la salud como un bien asegurable cuya protección se ha convertido en un derecho fundamental. En la misma línea, la asistencia sanitaria ha adquirido un carácter contractual, cuya "naturaleza" ha evolucionado de individual a colectiva, y que se expresa en términos de "seguro sanitario", sea público o privado. En tal contexto se hace necesaria la cuantificación de resultados para poder definir las variables del Sistema y, subsiguientemente, las condiciones de contratación Los resultados económicos son imprescindibles para conocer los costes y, en consecuencia, las necesidades financieras del Sistema; mientras que los resultados clínicos lo son para que el asegurado tenga unas expectativas realistas de los beneficios que puede esperar de la asistencia que se le ofrece. A su vez, el ritmo vertiginoso de innovación tecnológica que caracteriza la medicina moderna obliga a la continua revisión del estado del arte, encuadrado en un sector sanitario cuyo perfil multifactorial le confiere creciente complejidad. En conclusión, la evaluación de las tecnologías sanitarias se hace imprescindible para expresar la efectividad de la asistencia, posibilitar su gestión eficiente, definir responsabilidades y brindar garantías a los usuarios; todo lo cual ya forma parte de un cuerpo ético que, cada día con mayor nitidez, se va configurando en el Derecho y que, a su vez, es garantía de pervivencia del Sistema Asistencial (AU)

[Evaluation of health technologies and benefits entitlement in advanced social systems]. / Evaluación de las tecnologías sanitarias y ordenación de las prestaciones en los sistemas sociales avanzados.

In the present study, health is considered a subject of insurance whose protection has become a Fundamental Right. In the same line, health care has acquired a contractual character whose "nature" has evolved from individual to collective, expressed in terms of "health care insurance", public or private. In such context, outcome measurement becomes necessary to be able to define the variables of the System and, subsequently, the contracting conditions. Having an understanding of the economic impact is required to analyze the costs and, in consequence, the financial necessities of the System; as well as the clinical results in order for the insured to have some realistic expectations of the benefits that can be expected from the health care that is offered. In turn, the vertiginous rhythm of technological innovation that characterizes the modern medicine forces to the continuous revision of the state of the art framed in a health sector whose multifactorial profile confers it growing complexity. In conclusion, health technology assessment becomes indispensable to identify health care effectiveness, to facilitate its efficient management, to define responsibilities and to offer guarantees to the users; all which is already part of an ethical body that, day by day with more clarity, is being configured by the legislation and that, in turn, guarantees the survival of the Health Care System.