Predicción de resultados de cistoscopias en la práctica / Predicting Results of Daily-practice Cystoscopies

Objetivo: Elaborar un modelo predictivo de cáncer de vejiga en una población clínica no seleccionada derivada a cistoscopia. Materiales y métodos: Pacientes consecutivos sometidos a cistoscopia debida a sospecha o seguimiento de un cáncer de vejiga previamente diagnosticado. Todos los pacientes fueron sometidos a citología urinaria y un BTA-stat®-test (BTA). Para evitar sesgos de evaluación, BTA, citologías y cistoscopias fueron realizados de forma ciega. Usamos regresión logística para predecir los resultados de la cistoscopia a partir de citología, BTA y variables clínicas. Resultados: Entre agosto de 2011 y julio de 2012 seleccionamos 244 pacientes y 237 fueron válidos para el análisis. Un 13% fueron de nuevo diagnóstico y un 87% de seguimiento. Las sensibilidades de la citología y el BTA fueron 57,9% (IC 95%: 42,2-72,1) y 63,2% (IC 95%: 47,3-76,6) con especificidades de 84,4% (IC 95%: 78,7- 88,8) y 82,9% (IC 95%: 77,1-87,5). El modelo predictivo incluyó BTA, citología, tiempo transcurrido desde el diagnóstico del tumor previo y tratamiento con mitomicina o BGC en los últimos 3 meses. La precisión del modelo (AUC) fue 0,85 (0,78-0,92), y bajó a 0,79 al excluir el BTA (p = 0,026). En los casos de seguimiento, un umbral de 10% en las probabilidades predichas por el modelo resultó en un valor predictivo negativo de 95,7%, y 95,0% en los tumores de bajo grado. Conclusión: En un contexto de contención de costes nuestro modelo puede usarse para espaciar las cistoscopias en pacientes con tumores de bajo grado previos, resultando en un uso más eficiente de recursos del sistema de salud

Objective: Our objective was to elaborate a predictive model of bladder cancer, in an unselected clinical population submitted to cystoscopy. Materials and methods: We recruited consecutive patients who underwent cystoscopy due to suspicion of bladder cancer or surveillance of a previously diagnosed bladder cancer. Urine cytology and a BTA-stat® (BTA) test were carried out for all patients. To avoid an assessment bias, the BTA-tests, cytologies and cystoscopies were conducted in a blinded fashion. We used logistic regression to predict cystoscopy results from cytology, BTA-test and clinical variables. Results: From August 2011 to July 2012, we recruited 244 patients and 237 were valid for analysis. Newly diagnosed and surveillance cases were 13% and 87% respectively. Cytology and BTA-test sensitivities were 57.9% (CI 95: 42.2-72.1) and 63.2% (CI 95: 47.3-76.6) with specificities of 84.4% (CI 95: 78.7-88.8) and 82.9% (CI 95: 77.1-87.5). The predictive model included the BTA-test, cytology, time since previous tumor, and treatment with mitomicin or BGC during the last three months. The model predictive accuracy (AUC) was 0.85 (0.78-0.92), and dropped to 0.79 when excluding the BTA-test (p = 0.026). For the surveillance of bladder cancer, a 10% threshold on the model predicted probabilities resulted in an overall negative predictive value of 95.7%, and 95.0% in low grade tumors. Conclusion: In a cost containment environment, our prediction model could be used to space out cystoscopies in patients with previous, low grade tumors, resulting in a more efficient use of resources in the healthcare system

Predicting results of daily-practice cystoscopies.

OBJECTIVE: Our objective was to elaborate a predictive model of bladder cancer, in an unselected clinical population submitted to cystoscopy. MATERIALS AND METHODS: We recruited consecutive patients that underwent cystoscopy due to suspicion of bladder cancer or surveillance of a previously diagnosed bladder cancer. Urine cytology and a BTA-stat® (BTA) test were carried out for all patients. To avoid an assessment bias, the BTA-tests, cytologies and cystoscopies were conducted in a blinded fashion. We used logistic regression to predict cystoscopy results from cytology, BTA-test and clinical variables. RESULTS: From August 2011 to July 2012, we recruited 244 patients and 237 were valid for analysis. Newly diagnosed and surveillance cases were 13% and 87% respectively. Cytology and BTA-test sensitivities were 57.9% (CI 95: 42.2-72.1) and 63.2% (CI 95: 47.3-76.6) with specificities of 84.4% (CI 95: 78.7-88.8) and 82.9% (CI 95: 77.1-87.5). The predictive model included the BTA-test, cytology, time since previous tumour, and treatment with mitomicin or BGC during the last three months. The model predictive accuracy (AUC) was .85 (.78-.92), and dropped to 0.79 when excluding the BTA-test (P=.026). For the surveillance of bladder cancer, a 10% threshold on the model predicted probabilities resulted in an overall negative predictive value of 95.7%, and 95.0% in low grade tumours. CONCLUSION: In a cost containment environment, our prediction model could be used to space out cystoscopies in patients with previous, low grade tumours, resulting in a more efficient use of resources in the healthcare system.

[Effectiveness of self-measurement of blood pressure in patients with hypertension: the Dioampa study]. / Efectividad de la automedición de la presión arterial en pacientes hipertensos: estudio Dioampa.

OBJECTIVE: To evaluate the effectiveness of self-measurement of blood pressure (SMBP) in controlling hypertension. DESIGN: Randomized, controlled, pragmatic, open study. The unit of randomization was the basic health care unit (BCU), consisting of 1 physician and 1 nurse. All BCUs were randomized to the control group (usual clinical practice, n=94) or to the intervention group (n=86). SETTING: Primary care BCUs throughout Spain. PARTICIPANTS: Patients with poorly controlled essential hypertension, defined as systolic blood pressure > or = 140 or diastolic blood pressure > or = 90 mm Hg. INTERVENTIONS: The patients were given an OMRON HEM-705CP automatic blood pressure monitor on two occasions, for use during 15 days at weeks 6 and 14. Blood pressure was recorded at each visit (baseline, 6, 8, 14, 16, and 24 weeks). Main outcome measures. MAIN OUTCOME VARIABLE: control of blood pressure, considered systolic/diastolic blood pressure <140/90 mm Hg (130/85 in patients with diabetes). RESULTS: 180 BCUs serving 1325 patients (622 in the intervention group, 703 in the control group) participated. Baseline characteristics were similar in both groups. Immediately after the first period of SMBP (week 8) the proportion of patients whose blood pressure was well controlled was 7.6% higher in the intervention group than in the control group (P=.01). After the second period of SMBP (week 16) the difference between groups decreased to 4.1% (P=.27). At the end of the study the difference was 4.9% (P=.19). CONCLUSIONS: Self-measurement of blood pressure was effective in controlling blood pressure in the short term, but its effects faded over time.

Efectividad de la automedición de la presión arterial en pacientes hipertensos: estudio Dioampa / Effectiveness of self-measurement of blood pressure in patients with hypertension: the Dioampa study

Objetivo. Evaluar la efectividad de la automedición de la presión arterial (AMPA) sobre el control de la hipertensión arterial (HTA). Diseño. Estudio aleatorizado por grupos, controlado, pragmático y abierto. La unidad de aleatorización fue la unidad básica asistencial (UBA) compuesta por un médico/a y un enfermero/a. Las UBA fueron aleatorizadas al grupo control (grupo C, n = 94) bajo práctica clínica habitual, o al de intervención (grupo I, n = 86). Emplazamiento. UBA de atención primaria de toda España. Participantes. Pacientes con HTA esencial mal controlada definida como una presión arterial sistólica (PAS) o diastólica (PAD) ≥ 140 o 90 mmHg. Intervenciones. Se facilitaron medidores OMRON-HEM705CP en 2 ocasiones para su utilización durante 15 días (a las semanas 6 y 14). Se registró la presión arterial en cada visita de seguimiento (basal, 6, 8, 14, 16 y 24 semanas). Mediciones principales. Variable principal: control de la presión arterial considerada como PAS/PAD < 140/90 mmHg (130/85 mmHg en pacientes diabéticos). Resultados. Se incluyó a 1.325 pacientes de 185 UBA (622 en el grupo I y 703 en el grupo C), con características basales similares en ambos grupos. Inmediatamente después de la primera AMPA (semana 8), la proporción de pacientes bien controlados fue superior en el grupo I que en el C, con una diferencia del 7,6% (p = 0,01). Tras la segunda utilización (semana 16), esta diferencia se redujo al 4,1% (p = 0,27). Al final del estudio, la diferencia fue del 4,9% (p = 0,19). Conclusiones. La AMPA es efectiva en el control de la presión arterial a corto plazo, pero su efecto se amortigua con el tiempo

Objective.To evaluate the effectiveness of selfmeasurement of blood pressure (SMBP) in controlling hypertension. Design. Randomized, controlled, pragmatic, open study. The unit of randomization was the basic health care unit (BCU), consisting of 1 physician and 1 nurse. All BCUs were randomized to the control group (usual clinical practice, n=94) or to the intervention group (n=86). Setting. Primary care BCUs throughout Spain. Participants. Patients with poorly controlled essential hypertension, defined as systolic blood pressure ≥140 or diastolic blood pressure ≥90 mm Hg. Interventions. The patients were given an OMRON HEM-705CP automatic blood pressure monitor on two occasions, for use during 15 days at weeks 6 and 14. Blood pressure was recorded at each visit (baseline, 6, 8, 14, 16, and 24 weeks). Main outcome measures. Main outcome variable: control of blood pressure, considered systolic/diastolic blood pressure <140/90 mm Hg (130/85 in patients with diabetes). Results. 180 BCUs serving 1325 patients (622 in the intervention group, 703 in the control group) participated. Baseline characteristics were similar in both groups. Immediately after the first period of SMBP (week 8) the proportion of patients whose blood pressure was well controlled was 7.6% higher in the intervention group than in the control group (P=.01). After the second period of SMBP (week 16) the difference between groups decreased to 4.1% (P=.27). At the end of the study the difference was 4.9% (P=.19). Conclusions. Self-measurement of blood pressure was effective in controlling blood pressure in the short term, but its effects faded over time

Encuesta sobre la prescripción de genéricos en el ámbito de la atención primaria / Survey on the prescription of generic medicines in primary care

No disponible

[Statins consumption in autonomous communities in Spain: opportunities for savings]. / El consumo de estatinas en las comunidades autónomas de España: oportunidades para el ahorro.

OBJECTIVE: To identify opportunities for reducing the costs of the treatment of hypercholesterolaemia, using cost-effectiveness criteria for selecting statins. DESIGN: Modelling the costs of prescription guided by cost-effectiveness criteria. The most cost-effective statin was determined by reviewing the cost-effectiveness literature. The frequency with which different ways of reducing LDL-c are required was calculated from epidemiological data. From data on consumption (units) and cost (pesetas) of statin prescription in Spain in 1997, the potential saving to be gained through cost-effective prescription was calculated. MEASUREMENTS AND MAIN RESULTS: Possible savings in 1997 if statins had been prescribed according to cost-effectiveness criteria were calculated at between 5435 and 7027 million pesetas. CONCLUSION: There is a chance of optimising resource allocation in treating hypercholesterolaemia by selecting the most cost-effective statin on the basis of the need for LDL-c reduction.