Evaluación de la calidad asistencial en pacientes con diabetes tipo 2 del Área Sanitaria Cádiz-San Fernando / Evaluation of the quality of care of type 2 diabetic patients from the Health Area 2 Cádiz-San Fernando

Objetivo: Evaluar la calidad de la prestación de atención sanitaria al paciente con diabetes tipo 2 en un área básica de salud. Pacientes y métodos: Estudio observacional descriptivo de una muestra de 517 pacientes con diabetes tipo 2 conocida (intervalo de confianza 95%, nivel de riesgo alfa 0,05) atendidos en Atención Primaria y Endocrinología del área básica de salud Cádiz-San Fernando (228.000 habitantes). Se evalúa la calidad de la atención sanitaria aplicando los criterios de calidad propuestos por el Grupo Europeo de la Federación Internacional de Diabetes. Resultados: Se estudian 517 pacientes con diabetes tipo 2de 63,4 ± 12 años de edad media (59,4% mujeres) y 9,7 ± 8 años de evolución conocida de la diabetes. A pesar de la elevada prevalencia de factores de riesgo cardiovascular (HTA: 58%, dislipemia53%, obesidad: 40%, tabaquismo activo: 19%) y complicaciones crónicas de la diabetes (retinopatía 29%, nefropatía: 20%). El grado de cumplimiento en la realización de autoanálisis de glucemia capilar (35%), exploración anual de los pies (44%), determinación anual de albuminuria (47%) y de un perfil lipídico completo(51%) y participación en actividades educacionales (53%) fue insuficiente. Sin embargo, el porcentaje de determinación anual dehemoglobina glicosilada fue aceptable (81%).Conclusiones: Los pacientes con diabetes tipo 2 del área Cádiz-San Fernando presentan una elevada prevalencia de comorbilidades y complicaciones crónicas, evidenciándose la necesidad de mejora en el cumplimiento de las recomendaciones básicas para el cuidado y control de la enfermedad

Objective: The objective of our study was to evaluate the quality of health care in patients with type 2 in a health care area. Patients and methods: Observational descriptive study of a sample of 517 type 2 diabetes patients (confidence interval at 95% and sensibility at 5%) attended by Primary Care and Endocrinology of a Cádiz-San Fernando health care area (228,000 inhabitants). The quality of health care was evaluated applying the Guidelines of Diabetes Care of European Diabetes Policy Group of International Diabetes Federation. Results: A total of 517 patients with type 2 diabetes, with a mean age of 63.4 ± 12 years (59.4% women) and a mean period of disease evolution of 9.7 ± 8 years were assessed. Despite of great prevalence of cardiovascular risk factors (58% hypertension, 53% dislipemia, 40% obesity, 19% smoker) and chronic diabetes complications (29% retinopathy, 20% nephropathy), it was observed inadequate percentages in self-monitoring of blood glucose (35%), foot examination (44%) and yearly measure of urinary albumin excretion (47%) and blood lipid profile (51%) and patient education programme participation (53%). However, it was observed an adequate percentage of patients with at least one glycated haemoglobin determination at year (81%). Conclusion: Type 2 diabetes patients of Cádiz-San Fernando health care area present a great prevalence of comorbidities and chronic diabetes complications. It is necessary to improve the implementation of diabetes basic care recommendations and control of illness

Características clínicas y grado de control metabólico de paicentes hospitalizados con diabetes

El objetivo del estudio fue describir las principales características y el grado de control metabólico de los pacientes con diabetes mellitus que ingresan en nuestro hospital. Se diseñó un estudio descriptivo transversal que incluyese a toda la población diabética ingresada durante el período de una semana. A partir de encuestas individuales se evaluaron los antecedentes médicos, tratamientos realizados y diversos aspectos sobre los hábitos de vida y autocuidados de la enfermedad. EL nivel de control metabólico se evaluó a àrtir de la medición del nivel de hemoglobina glicosilada (HbA1c). Se estudiaron 158 pacientes con diabetes conocida (54 por ciento mujeres) con edad media de 65 +/- 13,7 años y tiempo medio de evolución de 13,5 +/-10 años. El 65,8 por ciento presentaba hipertensión arterial (HTA), el 41,7 por ciento dislipemia y el 9,5 por ciento era fumador. El 23,4 por ciento de los pacientes habían presentado úlcera o amputación distal y el 24,6 por ciento habían recibido láserterapia retiniana. La HbA1c media fue de 7,5 +/- 2,7 por ciento, no existiendo diferencias significativas entre los pacientes en seguimiento por atención primaria o especializada. En conclusión, los pacientes con diabetes mellitus ingresados en nuestro hospital presentan una elevada prevalencia de factores de riesgo cardiovascular y de complicaciones crónicas de la diabetes. Sin embargo, los porcentajes obtenidos probablemente infravaloran la prevalencia real entre la población hospitalizada con diabetes (AU)

[Dietary-therapeutic product supply in unitary doses at a university hospital: effect on consumption and costs]. / Dispensación de los productos dietoterapéuticos mediante dosis unitarias en un hospital universitario: efectos sobre el consumo y costes.

GOALS: To analyze the consumption and costs of the Enteral Nutrition products (diets and dietary supplements) dispensed from the Nutrition unit in a 735-bed general hospital during two six-month periods, before and after the implementation of a unit-dose (UD) distribution system. MATERIALS AND METHODS: The defined daily dose (DDD) methodology was used. A DDD of 1,500 Kcal/day was defined for complete diets in adults, with 1,000 Kcal/day for complete diets in children, 1,200 Kcal/day for "start-up" diets, 500 Kcal/day for normocaloric supplements and 600 Kcal/day for hypercaloric supplements and 450 Kcal for very low caloire diets. RESULTS: The total consumption in the hospital fell from 10.21 DDD per 100 stays/day (DED in its Spanish acronym), representing generated costs of 8,640,130 pesetas between November, 1997, and April, 1998, to 6.25 DED in the same period for 1998-99, with costs amounting to 6,674,775 pesetas (-23%). In the services handled using UD, the total consumption declined from 9.3 DED between November, 1997, and April, 1998, to 5.2 DED in the same period for 1998-99. The consumption of standard/special diets and dietary supplements went from 1.38/0.76/7.16 DED to 1.48/0.53/3.19 DED during the two periods under study, with an accompanying drop in costs of -1,806,598 pesetas (-30%). In percentage terms, the standard diets varied from 26% to 41% (of the total cost generated in the services with UD), special diets from 28% to 22% and dietary supplements from 54% to 37%. In those services where the UD was not applied (ICU and reanimation), the total consumption of diets remained stable with a slight drop from 25.3 DED to 24.3 DED. CONCLUSIONS: The unit dose system has improved the prescription of therapeutic dietary products in our hospital and has reduced the costs, mainly through the notable decrease in the dispensation of supplements.

Dispensación de los productos dietoterapéuticos mediante dosis unitarias en un hospital universitario: efectos sobre el consumo y costes / Dispensation of therapeutic dietary products by means of unit doses in a teaching hospital: effects on consumption and costs

Objetivos: Analizar el consumo y los costes de los productos de nutrición enteral (dietas y suplementos) dispensados en un hospital general de 735 camas durante dos períodos de seis meses, antes y después de la implementación de un sistema de distribución por dosis-unitarias (UD), desde la unidad de Nutrición. Material y métodos: Se empleó la metodología de las dosis-diaria-definidas (DDD). Se definió 1 DDD para dietas completas de adultos en 1.500 kcal/día, 1.000 kcal/día para dietas completas pediátricas, 1.200 kcal para dietas "de inicio", 500 kcal/día para suplementos normocalóricos y 600 kcal/día para hipercalóricos y 450 kcal para las dietas de muy bajo contenido calórico. Resultados: El consumo total hospitalario descendió de 10,21 DDD/100 estancias/día (DED), con unos costes generados de 8.640.130 ptas. en noviembre-abril de 1997/1998, a 6,25 DED en el mismo período de 1998/1999 con unos costes de 6.674.775 ptas. (- 23 por ciento). En los servicios atendidos mediante UD el consumo total descendió de 9,3 DED en noviembre-abril de 1997/1998 a 5,2 DED en el mismo período de 1998/1999. El consumo de dietas estándar/especiales/suplementos pasó de 1,38/0,76/7,16 DED a 1,48/0,53/3,19 DED en los períodos estudiados con un descenso acompañante de los costes de - 1.806.598 ptas. (- 30 por ciento). Porcentualmente las dietas estándar variaron del 26 por ciento al 41 por ciento (del total de los costes generados en los servicios con UD), las especiales de¡ 28 por ciento al 22 por ciento y los suplementos del 54 por ciento al 37 por ciento. En los servicios donde no se aplicó la UD (UCI y reanimación) el consumo total de dietas se mantuvo estable con un ligero descenso de 25,3 DED a 24,3 DED. Conclusiones: El sistema de unidosis ha mejorado la prescripción de productos dietoterapéuticos en nuestro hospital y ha disminuido los costes, principalmente por el notable descenso de la dispensación de suplementos (AU)

Goals: To analyze the consumption and costs of the Enteral Nutrition products (diets and dietary supplements) dispensed from the Nutrition unit in a 735-bed general hospital during two six month periods, before and after the implementation of a unit-dose (UD) distribution system. Materials and Methods: The defined daily dose (DDD) methodology was used. A DDD of 1,500 Kcal/day was defined for complete diets in adults, with 1,000 Kcal/day for complete diets in children, 1,200 Kcal/day for "start-up" diets, 500 Kcal/day for normocaloric supplements and 600 Kcal/day for hypercaloric supplements and 450 Kcal for very low caloire diets. Results: the total consumption in the hospital fell from 10.21 DDD per 100 stays/day (DED in its Spanish acronym), representing generated costs of 8,640,130 pesetas between November, 1997, and April, 1998, to 6.25 DED in the same period for 1998-99, with costs amounting to 6,674,775 pesetas (-23%). In the services handled using UD, the total consumption declined from 9.3 DED between November, 1997, and April, 1998, to 5.2 DED in the same period for 1998-99. The consumption of standard/special diets and dietary supplements went from 1.38/0.76/7.16 DED to 1.48/0.53/3.19 DED during the two periods under study, with an accompanying drop in costs of — 1,806,598 pesetas (— 30%). In percentage terms, the standard diets varied from 26% to 41% (of the total cost generated in the services with UD), special diets from 28% to 22% and dietary supplements from 54% to 37%. In those services where the UD was not applied (ICU and reanimation), the total consumption of diets remained stable with a slight drop from 25.3 DED to 24.3 DED. Conclusions: The unit dose system has improved the prescription of therapeutic dietary products in our hospital and has reduced the costs, mainly through the no-table decrease in the dispensation of supplements (AU)

[Serial assessment of the nutritional status of patients infected by the human immunodeficiency virus. Role of tumor necrosis factor/its receptors]. / Valoración seriada del estado nutricional de enfermos infectados por el virus de la inmunodeficiencia humana. Papel del sistema factor de necrosis tumoral/receptores del mismo.

In order to analyze the nutritional status of HIV infected patients and the involvement of the tumour necrosis factor-alpha (TNF-alpha) and its soluble receptors (sTNFRI and sTNFRII) in such an status, forty HIV infected patients, with no associated systemic opportunist infections, were prospectively followed for eight months. From each patient the following were obtained: clinical history, dietetic survey, anthropometric measurements, CD4+ T lymphocyte/mm3 count, HIV load, and serum concentration of TNF and sTNFRI and sTNFRII. Patients showed a nutritional disorder which involved mainly the fat compartment (mean tricipital skin fold 9.8 +/- 4.2 mm, that is, 65.7 +/- 27.4% of the ideal fold), associated with a hypocaloric intake (mean daily intake 1,659.5 +/- 543.0 kcal), with normal proportions of the different organic principles. Serum concentrations of TNF (87.9 +/- 79.2 vs 8.7 +/- 6.1 pg/ml, p = 0.048) and its receptors, sTNFRI (6.1 +/- 2.6 vs 1.0 +/- 0.8 pg/ml, p < 0.001) and sTNFRII (41.9 +/- 18.6 vs 6.3 +/- 3.6 pg/ml, p < 0.001) were significantly higher than those detected in a sample of ten healthy controls. No correlation was found between nutritional alterations and concentrations of TNF or its receptors, viral load, and counts of CD4+ T lymphocytes/mm3. Seventeen patients completed the follow-up period. During this period, no significant modifications in the analyzed parameters were observed: tricipital skin fold, arm circumference, serum concentrations of albumin or transferrin, concentrations of tumoral necrosis factor or its receptor and caloric intake. The conclusion is that, despite the detected nutritional alterations in the nutritional status and those in the TNF/receptor system, our data no support and interrelationship between them.