HER-2 gene amplification by chromogenic in situ hybridisation (CISH) compared with fluorescence in situ hybridisation (FISH) in breast cancer-A study of two hundred cases.

The purpose of the study was to compare two methods used to analyse HER-2 gene amplification (fluorescence in situ hybridisation (FISH) and chromogenic in situ hybridisation (CISH)), and determine the accuracy of the antibodies CB11 and HercepTest for immunohistochemical detection of HER-2 overexpression from archival breast cancer tissue. Additionally, interobserver variability in the interpretation of CISH and immunohistochemical tests was measured. Two hundred cases of invasive breast carcinoma diagnosed between 2000 and 2003 were selected. Immunohistochemistry (IHC) was performed with HercepTest and CB11, and gene amplification was determined by FISH (PathVision, Vysis) and CISH (Zymed) using tissue macroarrays. An excellent concordance (94.8%) was found between CISH and FISH. Considering FISH as gold standard, sensitivity of CISH was 97.5% and specificity 94%. Overall interobserver agreement of CISH was 97.5% and of IHC 84%. Both antibodies showed a sensitivity of 95.2% and a specificity of 70.7% (CB11) and 81.2% (HercepTest). Our results show that CISH is a highly accurate, reproducible and practical technique to determine HER-2 gene amplification. CB11 and HercepTest are good screening methods with a high sensitivity. The performance of tissue macroarrays to test HER-2 status by IHC, FISH and CISH has demonstrated to be an available and effective method to study large series of tumours.

Prevalencia de la insuficiencia renal en la población general mayor de 64 años y episodios cardio-vasculares asociados / Prevalence of chronic kidney disease in community-dwelling elderly and associated cardiovascular risk factors

Fundamento: En los últimos años se está observando un aumento en la incidenciade la enfermedad renal crónica en los países desarrollados. La poblaciónde edad avanzada constituye el sector más numeroso de pacientes incidentes enlos programas de diálisis. Por otra parte, la insuficiencia renal constituye por símisma un factor de riesgo cardiovascular, ya evidenciable en las fases iniciales desu desarrollo. Existe un notable desconocimiento sobre la prevalencia de la enfermedadrenal en la población general. El objetivo fue conocer el grado de funciónrenal en nuestra población general mayor de 64 años, así como el riesgo cardiovascularasociado.Material y métodos: Estudio epidemiológico descriptivo mediante muestreo aleatoriorepresentativo de la población mayor de 64 años del área de referencia denuestro Hospital. El filtrado glomerular se ha estimado mediante las fórmulas deCockroft-Gault y del MDRD. Se han clasificado por estadios según la K/DOQI.Resultados: Analizamos 253 personas entre 65 y 93 años (media 72 ± 5,4). Comorbilidades:HTA 64%, dislipemia 29%, diabetes 14%, tabaquismo activo: 10%de los hombres, 1,5% de las mujeres. 11% habían presentado algún evento cardiovascular(15% hombres, 6,8% mujeres). El 3,8% de las mujeres y el 8% delos hombres presentaron valores de creatinina > 1,3 y > 1,5 mg/dl respectivamente.Sin embargo, la prevalencia de insuficiencia renal (Cl < 60 mlx’) fue del31-49% en función de la fórmula utilizada. Además de la edad, el sexo y la diabetes,la pérdida de función renal se asoció significativa e independientementecon la existencia de eventos cardiovasculares.Conclusiones: Se confirmó una elevada prevalencia de insuficiencia renal entrelas personas mayores, a menudo no detectada mediante la determinación aisladade la creatinina plasmática. Este hecho es importante en la valoración del riesgocardiovascular y en la toma de decisiones médicas (diagnósticas y/o terapéuticas).La estimación del filtrado glomerular mediante simples ecuaciones se asoció independientementea la existencia de eventos cardio-vasculares

Background: Chronic kidney disease is a major public health problem in developedcountries. The incidence of patients on dialysis is increasing progressively inthe last years. The ageing population and increasing incidence of diabetes and hypertensionare the main causes. Moreover, the level of kidney function is now recognisedas a major risk factor for cardiovascular disease, even in mild cases. Thereis a great unaware about the prevalence of mild to moderate chronic kidney diseasein the general population. The aim of the present study was to know thekidney function level in our general population over 64 years old, and the associatedcardiovascular risk.Methods: This is an epidemiological descriptive cross-sectional study, obtainedby a representative random sampling of the population over 64 years living in thereference area of our Hospital. The glomerular filtration rate was estimated by theCockroft-Gault formula and the MDRD equations. Kidney function has been classifiedby the K/DOQI stages. We examined the univariate and multivariate associationbetween the estimated glomerular filtration rate and the presence of cardiovascularevents.Results: We analysed 253 subjects aged 65 to 93 years (mean 72 ± 5.4). Presentcomorbidities were: HTA 64%, dislipemia 29%, diabetes 14%, active smokers:10% of men, 1,5% of women. A previous cardiovascular event was presentin 11% of patients (15% of men; 6,8% of women). A serum creatinin level over1,3 and 1,5 mg/dl was present in 3,8% of women and 8% of men respectively.Nevertheless, chronic kidney insufficiency (estimated clreatinie clearance less than60 mlx’) was present in 31-49% relying on the utilised formula. In addition toage, sex, and diabetes, an independent graded association was observed betweenreduced glomerular filtration rate and the existence of cardiovascular events.Conclusions: We have confirmeda high prevalence of renal insufficiency amongelderly people, usually not detected by the isolated plasma creatinin concentrationThis aspect is important for cardiovascular stratification risk and medical decisions(diagnostic and/or therapeutic). The level of glomerular filtration rate is independentlyassociated with cardiovascular events

[Prevalence of chronic kidney disease in community-dwelling elderly and associated cardiovascular risk factors]. / Prevalencia de la insuficiencia renal en la población general mayor de 64 años y episodios cardio-vasculares asociados.

BACKGROUND: Chronic kidney disease is a major public health problem in developed countries. The incidence of patients on dialysis is increasing progressively in the last years. The ageing population and increasing incidence of diabetes and hypertension are the main causes. Moreover, the level of kidney function is now recognised as a major risk factor for cardiovascular disease, even in mild cases. There is a great unaware about the prevalence of mild to moderate chronic kidney disease in the general population. The aim of the present study was to know the kidney function level in our general population over 64 years old, and the associated cardiovascular risk. METHODS: This is an epidemiological descriptive cross-sectional study, obtained by a representative random sampling of the population over 64 years living in the reference area of our Hospital. The glomerular filtration rate was estimated by the Cockroft-Gault formula and the MDRD equations. Kidney function has been classified by the K/DOQI stages. We examined the univariate and multivariate association between the estimated glomerular filtration rate and the presence of cardiovascular events. RESULTS: We analysed 253 subjects aged 65 to 93 years (mean 72 +/- 5.4). Present comorbidities were: HTA 64%, dislipemia 29%, diabetes 14%, active smokers: 10% of men, 1,5% of women. A previous cardiovascular event was present in 11% of patients (15% of men; 6,8% of women). A serum creatinin level over 1,3 and 1,5 mg/dl was present in 3,8% of women and 8% of men respectively. Nevertheless, chronic kidney insufficiency (estimated clreatinie clearance less than 60 mix') was present in 31-49% relying on the utilised formula. In addition to age, sex, and diabetes, an independent graded association was observed between reduced glomerular filtration rate and the existence of cardiovascular events. CONCLUSIONS: We have confirmed a high prevalence of renal insufficiency among elderly people, usually not detected by the isolated plasma creatinin concentration This aspect is important for cardiovascular stratification risk and medical decisions (diagnostic and/or therapeutic). The level of glomerular filtration rate is independently associated with cardiovascular events.

Factors related to non-participation in a population-based breast cancer screening programme.

The main objectives were to describe the measures taken by women to detect breast disease prior to invitation to participate in a screening programme for breast cancer, and to identify factors related to non-participation in this programme. A cross-sectional study was designed at the Breast Cancer Early Detection Program of Sabadell-Cerdanyola (BCEDP), using data collected in interviews conducted face to face or over the telephone with 13 760 women participating in the programme and 280 non-participants. A total of 74.2% of the participants versus 70.4% of the non-participants reported having taken measures to detect breast disease, and 71.7% of the participants had undergone mammography versus 69.6% of the non-participants. Of the 10 057 women who had had mammograms, 58% had done so less than 2 years previously. Factors found to be associated to non-participation in the multivariate analysis were: higher level of education, higher occupational skills or working at home, self- or gynaecological examination of breasts, and having received hormone replacement therapy. Higher age group was the only factor that increased the probability of not having undergone mammography previously. Despite the high prevalence of prior measures to detect breast cancer and the similar prevalence between participating and non-participating women, this behaviour is much less prevalent in the group of women 60 years of age or older.

[Establishment of a database on health care outcomes studies]. / Establecimiento de una base de datos para estudios de resultados sobre la atención sanitaria.

BACKGROUND: In 1992 a European initiative called the European Clearing Houses on Health Outcomes (ECHHO) was started in the UK. Its objectives in Spain were to establish a database for those projects on the evaluation of results from clinical practice developed from 1990 onward and linked with those from other European countries, and to disseminate this initiative in our area. MATERIAL AND METHODS: The project was based on the identification of studies initiated from 1990 onward and the establishment of a database available on the World Wide Web. The Annals of the Health Investigation Fund (FIS) from 1990 to 1995 were revised and professionals who were developing clinical investigation activities were contacted. The inclusion criteria for the studies encompassed: the evaluation of the results from patients' health care, the utilization of indicators in initiatives or evaluations on the quality of health care or on the effectiveness of health care interventions, as well as the validation and development of measures for health status. RESULTS: The database is available at http:¿www.cspt.es/ecltho. A total of 139 projects have been identified from the Annals of the FIS and 59 from other contacts. The majority (105 projects) corresponded to effectiveness studies and 29 to studies of the development or validation of instruments, mainly in patients with oncological, cardiovascular, or chronic respiratory diseases, but also in the general patient population. CONCLUSION: Research on health care outcomes in Spain is a matter of interest. Information systems should form part of a stable strategy with responsibility on research.

Appropriateness of admissions and hospitalization days in an acute-care teaching hospital.

A cross-sectional study was made of the appropriateness of admissions and hospitalization days in an high-technology, acute-care teaching hospital. This 952-bed institution with 31 hospital services is a reference center for the metropolitan area of Barcelona. A systematic random sampling (1:11) of the registers of hospital discharges was carried out during the months of January, February and March 1991 (n = 7,142) excluding discharges from the pediatric, obstetrics and psychiatric departments. A retrospective analysis was made of 639 patients' medical records using the Appropriateness Evaluation Protocol (AEP). The rate of inappropriate hospital admissions was 9.1% (58/639) (95% confidence interval: 6.9-11.5). Inappropriate admissions were primarily attributable to hospitalizations for diagnostic and/or therapeutic services that could have been rendered on an ambulatory basis (70.7% of cases). Overall 29.2% of hospitalization days (1,963/6,731) were inappropriate (95% confidence interval: 28.1-30.3). Inappropriate admissions to hospital, an optimizable health care planning and a conservative physician's attitude (postponed discharge) were the most frequent reasons for unnecessary days of care. The interrater reliability in the use AEP criteria for appropriateness of admission showed a kappa index of 0.5 and that for appropriateness of hospitalization days 0.67. In summary, instruments, such as the AEP protocol, that allow us to determine which patients can be attended at other levels of the health care system and which levels are the most appropriate, are key elements in improving the appropriateness of hospital use in public health care systems.

[The vaccination of medical and nursing students against hepatitis B]. / Vacunación de estudiantes de medicina y enfermería frente a la hepatitis B.

BACKGROUND: Vaccination against the hepatitis B virus (HBV) of health care staff during their studies would have the advantage of early prevention when the prevalence of infection is presumably low. METHODS: The population to be protected is made up of 1533 medical and nursing students. In those who accepted, anti-HBc was determined and information was obtained concerning circumstances of exposure to HBV. Vaccination was offered to all the cases of negative anti-HBc. Individuals receiving 3 doses of the vaccination (20 micrograms at 0, 1 and 6 months) were seen at 4-7 months of the last dose to determine the anti-HBs titers achieved. RESULTS: One thousand sixty-five students (70%) accepted inclusion into the prevaccination anti-HBc study and 1,029 (3.4%) were anti-HBc negative. Only older age and previous transfusions and jaundice were significantly associated to greater prevalence of infection by HBV. The adherence to 1, 2 or 3 doses of the vaccination was 96%, 94% and 87%, respectively. Following the 3 doses, > or = 10 UI/I of anti-HBs were detected in 97% of the cases studied with geometric measurement of the responders being 1580 U/I. The titer had an inverse relation which was not significant with age. CONCLUSIONS: The high participation in the program of anti-hepatitis B vaccination and the excellent immune response observed leads to the recommendation of systemic vaccination to future health care professionals during their study period. Furthermore, the low prevalence of previous HBV infection advises against previous detection of anti-HBc with immunization of the whole collective being more effective.

[The quality perceived by the consumers of the outpatient consultation services of a university hospital]. / Calidad percibida por los usuarios de consultas externas de un hospital universitario.

With the objective to know the perceived quality of the assistance by the customers of the outpatient facilities in a teaching hospital, the information gathered in 1,970 self-administered, volunteer, anonymous questionnaires was analyzed, being obtained from the 4,756 consultations done in the outpatients department during a one week period. Different aspects of the physician's visit are discussed, together with the attention received from the paramedic personnel and other viewpoints pertaining to the organization and conditions of the waiting area. There is a high level of satisfaction among the users of the outpatients department, more pronounced in the "medical" area, in relation with the physician's consultation as well as with the attention from paramedics or in the adherence to appointments. The results suggest that in those physicians' offices where the relationship of the patient with the unit is less frequent, users show more criticism in comparison with those offices where almost all patients consult because of chronic ailments. We underline the importance of this type of perceived quality studies within the quality control policies, as a complement of the analysis of technical quality.

[Risk of nosocomial infection in elderly patients admitted to a university hospital]. / Riesgo de infección nosocomial de los pacientes ancianos ingresados en un hospital universitario.

BACKGROUND: A high percentage of current hospital visits are made by the elderly. The aim of this work is to quantify the risk of contracting a nosocomial infection among elderly patients admitted to a university hospital. METHODS: From the patients admitted from the emergency unit, outpatients and the waiting list, 6 patients of different age groups were chosen each day by a simple random sampling. The criteria of nosocomial infection were those of the CDC. The analysis of the information was made with the programme EPIINFO version 5. The chi 2 tests and Fisher's exact test were used to compare proportions. RESULTS: The rate of nosocomial infection in the group aged over 64 was 14.8%, showing statistically significant differences with respect to other age groups (p = 0.001). In this group the predominant infection was urinary, with an odds-ratio of 3.69, in comparison with the 25 to 44 age group. A prolonged hospital stay (> 15 days) has proved to be closely related to the risk of nosocomial infection in all age groups (p < 0.0001) in patients over 64. CONCLUSIONS: The greater risk of contracting nosocomial infections in the elderly makes it advisable to develop specific prevention programmes for this group, and the fitness of accommodations the length of stay to the care needs suitable to the hospital level.