Cooperación para la innovación europea en el envejecimiento activo y saludable: de la política a la acción / European innovation partnership on active and healthy aging: moving from policy to action

El envejecimiento es un reto común en la Unión Europea, que incrementará la necesidad de ayuda a domicilio y el consumo de servicios sanitarios, presionando con ello nuestro sistema de bienestar. Una visión más colaborativa, integrada y centrada en el paciente-ciudadano parece ofrecer una respuesta más sostenible y eficiente a los modelos actuales. Abordajes innovadores para la patología crónica y la prevención del deterioro funcional permitirán vivir más y con mejor calidad de vida. Para hacer realidad el potencial beneficio de estas intervenciones, la Comisión Europea, en su política de "Unión para la innovación", ha lanzado la iniciativa "Cooperación para la innovación europea en el envejecimiento activo y saludable". La promoción de la participación y la colaboración de todos los actores en la cadena de cuidados son esenciales. Este artículo describe el fundamento teórico, el desarrollo de la iniciativa, sus expectativas y las primeras acciones (AU)

Demographic change and aging are a common challenge in Europe. The rising number of elderly people will need support at home, and will consume more healthcare services, putting further pressure on the welfare system. Collaborative, integrated and people-centered care provision, whether in hospitals, homes or in the community, is a way forward to sustainable and efficient care systems. Innovative treatments to address chronic diseases and the functional decline of older people will enable them to live longer in better health and with a better quality of life. To fully unleash the potential of aging in the European Union, the European Commission -within its Innovation Union policy- launched the first European Innovation Partnership on Active and Healthy Ageing (EIP AHA). Promoting engagement and partnerships among all stakeholders in the healthcare chain is essential. This article describes the theoretical foundations, the development and expectations of the initiative, and its first actions (AU)

Cooperación para la Innovación Europea sobre el Envejecimiento Activo y Saludable / European Innovation Partnership on Active and Healthy Ageing

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[European innovation partnership on active and healthy aging: moving from policy to action]. / Cooperación para la innovación europea en el envejecimiento activo y saludable: de la política a la acción.

Demographic change and aging are a common challenge in Europe. The rising number of elderly people will need support at home, and will consume more healthcare services, putting further pressure on the welfare system. Collaborative, integrated and people-centered care provision, whether in hospitals, homes or in the community, is a way forward to sustainable and efficient care systems. Innovative treatments to address chronic diseases and the functional decline of older people will enable them to live longer in better health and with a better quality of life. To fully unleash the potential of aging in the European Union, the European Commission -within its Innovation Union policy- launched the first European Innovation Partnership on Active and Healthy Ageing (EIP AHA). Promoting engagement and partnerships among all stakeholders in the healthcare chain is essential. This article describes the theoretical foundations, the development and expectations of the initiative, and its first actions.

Limitación del tratamiento en una unidad de cuidados intensivos / Limitation of therapy in an intensive care unit

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What about telepsychiatry? A systematic review.

BACKGROUND: Mental illness has become a significant worldwide health issue in recent years. There is presently insufficient evidence to definitively determine the clinical effectiveness and cost-effectiveness of different health care models. The objective of this study was to evaluate the effectiveness of videoconferencing in mental illness. DATA SOURCES: Literature searches were performed in Medline, EMBASE, PsycINFO, Centre for Reviews and Dissemination, and The Cochrane Library Controlled Trial Registry databases (1997-May 2008). A search of the following terms was used: e-health, mental disorders (MeSH term), mental health (MeSH term), mental health services (MeSH term), telecare, teleconsultation, telehome, telemedical, telemedicine, telemental, telepsychiatric, telepsychiatry, televideo, videoconference, and videophone. STUDY SELECTION: Type of disease, interventions, and clinical outcomes or patient satisfaction were identified. Exclusion criteria included studies that did not analyze intervention outcomes and studies with a sample size of fewer than 10 cases. Peer review and quality assessment according to Cochrane recommendations were required for inclusion. DATA EXTRACTION/SYNTHESIS: Of 620 identified articles, 10 randomized controlled trials are included (1,054 patients with various mental disorders). There were no statistically significant differences between study groups for symptoms, quality of life, and patient satisfaction. CONCLUSIONS: There is insufficient scientific evidence regarding the effectiveness of telepsychiatry in the management of mental illness, and more research is needed to further evaluate its efficiency. However, there is a strong hypothesis that videoconference-based treatment obtains the same results as face-to-face therapy and that telepsychiatry is a useful alternative when face-to-face therapy is not possible.

Telemedicine for depression: a systematic review.

PURPOSE: More than 14% of the population has a mood disorder, and more than 50% do not receive treatment. Information and communication technology (ICT) could improve health care. A systematic review was considered in order to know the programs that apply ICT in the management of depression and to assess their effectiveness. CONCLUSION: There is insufficient scientific evidence regarding the effectiveness of ICT use in the management of depression. However, there is a well-founded hypothesis that videoconference produces the same results as face-to-face treatment and that self-help Internet programs could improve symptoms. PRACTICE IMPLICATIONS: More research is needed; nevertheless, when traditional care is not possible, telemedicine could be used.

[Effectiveness of spinal manipulation in treating whiplash injuries]. / Efectividad de las técnicas de manipulación espinal en la "lesión por latigazo" (whiplash).

OBJECTIVE: To assess the efficacy of spinal manipulation treatments in patients with whiplash injuries. DESIGN: Systematic review. DATA SOURCES: A systematic search was conducted between January 2000 and May 2006 in CINAHL, the Cochrane Library, EMBASE, MEDLINE, CRD (Center for Reviews and Dissemination), Spanish Index Medicus, and PEDro. Reports of Physiotherapy congresses between 2000 and 2005 were reviewed. INCLUSION CRITERIA: studies of patients with whiplash injuries who were treated with spinal manipulations, either exclusively or combined with other therapies. Outcomes were expressed in at least one of the following: pain, global perceived effect or range of movement (ROM). Only 9 of the first screening (290) were analyzed. DATA EXTRACTION: The studies were independently selected by 2 reviewers. Methodological quality was assessed on the basis of the recommendations of the Agency for Health Technology Evaluation. The lack of data and their heterogeneity made any statistical analysis impossible. RESULTS: Of the 9 studies analyzed, 7 were systematic reviews and 2 were primary studies. No review showed evidence of the efficacy of spinal manipulations versus other therapies. The results were often explained vaguely and inadequately. CONCLUSIONS: There is not enough evidence to suggest that spinal manipulation is an effective treatment for whiplash. Though in the short term it seems to improve pain, any long-term benefit or clinical or economic advantages versus conventional therapies could not be determined.

Efectividad de las técnicas de manipulación espinal en la «lesión por latigazo» (whiplash) / Effectiveness of spinal manipulation in treating whiplash injuries

Objetivo. Evaluar la eficacia de las manipulaciones espinales en pacientes con «síndrome del latigazo cervical» (whiplash) (SLC). Diseño. Revisión sistemática. Fuentes de datos. Búsqueda sistemática desde enero de 2000 hasta mayo de 2006 en: CINAHL, The Cochrane Library, EMBASE, MEDLINE, Centre for Reviews and Dissemination Index Medicus, PEDro y libros de ponencias de congresos de fisioterapia desde 2000 hasta 2005. Selección de estudios. Criterios de inclusión: estudios de pacientes con SLC y tratamiento basado en manipulaciones espinales exclusivas o combinadas con otras técnicas. Los resultados debían expresarse en al menos uno de los siguientes términos: dolor, efecto general percibido o amplitud de movimientos. Extracción de datos. Los artículos fueron seleccionados por 2 revisores de forma independiente. El análisis de la calidad metodológica se realizó siguiendo las recomendaciones de la Agencia de Evaluación de Tecnologías Sanitarias. La escasez y variedad de los datos encontrados imposibilitaron su análisis estadístico. Resultados. De 290 documentos encontrados se analizaron 9: 7 eran revisiones y 2, estudios primarios. En general, ninguna de las revisiones mostraba pruebas de que las técnicas manipulativas fueran más efectivas que otros tratamientos. La exposición de los resultados era en muchos casos vaga y defectuosa. Conclusiones. No se han encontrado pruebas suficiente de que las manipulaciones espinales sean un tratamiento efectivo del SLC. Aunque parece que a corto plazo produce una mejoría del dolor, no se puede confirmar su evolución a largo plazo, ni sus ventajas clínicas o económicas frente a los tratamientos convencionales

Objective. To assess the efficacy of spinal manipulation treatments in patients with whiplash injuries. Design. Systematic review. Data sources. A systematic search was conducted between January 2000 and May 2006 in CINAHL, the Cochrane Library, EMBASE, MEDLINE, CRD (Center for Reviews and Dissemination), Spanish Index Medicus, and PEDro. Reports of Physiotherapy congresses between 2000 and 2005 were reviewed. Study selection. Inclusion criteria: studies of patients with whiplash injuries who were treated with spinal manipulations, either exclusively or combined with other therapies. Outcomes were expressed in at least one of the following: pain, global perceived effect or range of movement (ROM). Only 9 of the first screening (290) were analyzed. Data extraction. The studies were independently selected by 2 reviewers. Methodological quality was assessed on the basis of the recommendations of the Agency for Health Technology Evaluation. The lack of data and their heterogeneity made any statistical analysis impossible. Results. Of the 9 studies analyzed, 7 were systematic reviews and 2 were primary studies. No review showed evidence of the efficacy of spinal manipulations versus other therapies. The results were often explained vaguely and inadequately. Conclusions. There is not enough evidence to suggest that spinal manipulation is an effective treatment for whiplash. Though in the short term it seems to improve pain, any long-term benefit or clinical or economic advantages versus conventional therapies could not be determined

New technologies for chronic disease management and control: a systematic review.

We conducted a systematic review of the clinical effectiveness of interventions using information and communication technologies (ICTs) for managing and controlling chronic diseases. Electronic databases were searched for randomized clinical trials that assessed the effectiveness of ICTs (except for those that included only telephone communication) and measured some clinical indicator. Information was reviewed and assessed independently by two researchers. Of the 950 clinical trials identified, 56 studies were identified for potential inclusion. Of those, 24 were finally included: 5 studies in asthma, 3 in hypertension, 1 in home telecare, 7 in diabetes, 6 in heart failure and 2 in prevention heart disease. Overall, ICT applications did not show an improvement in clinical outcomes, although no adverse effects were identified. However, ICTs used in the detection and follow up of cardiovascular diseases provided better clinical outcomes, mortality reduction and lower health services utilization. Systems used for improving education and social support were also shown to be effective. At present the evidence about the clinical benefits of ICTs for managing chronic disease is limited.

Long-term outcome in ICU patients: what about quality of life?

OBJECTIVE: Analysis of mortality and quality of life (QOL) after intensive care unit (ICU) discharge. DESIGN: Prospective, observational study. SETTING: Mixed, 31-bed, medico-surgical ICU. PATIENTS: Consecutive adult ICU admissions between June 25 and September 10, 2000, except admissions for uncomplicated elective postoperative surveillance. INTERVENTIONS. None. MEASUREMENTS AND RESULTS: Age, past history, admission APACHE II, SOFA score (admission, maximum, discharge), ICU and hospital mortality were recorded. A telephone interview employing the EuroQol 5D system was conducted 18 months after discharge. Of 202 patients, 34 (16.8%) died in the ICU and 23 (11.4%) died in the hospital after ICU discharge. Of the 145 patients discharged alive from hospital, 22 could not be contacted and 27 (13.4%) had died after hospital discharge. Of the 96 patients (47.5%) who completed the questionnaire, 38% had a worse QOL than prior to ICU admission, but only 8.3% were severely incapacitated. Twenty-three patients (24%) had reduced mobility, 15 (15.6%) had limited autonomy, 24 (25%) had alteration in usual daily activities, 29 (30.2%) expressed more anxiety/depression, and 42 (44%) had more discomfort or pain. Twenty-eight (62.2% of those who worked previously) patients had returned to work 18 months after ICU discharge. CONCLUSIONS: Comparing QOL after discharge with that before admission, patients more frequently report worse QOL for the domains of pain/discomfort and anxiety/depression than for physical domains. Factors commonly associated with a change in QOL were previous problems in the affected domains, prolonged hospital length of stay (LOS), greater disease severity at admission and degree of organ dysfunction during ICU stay.

Mortalidad y calidad de vida al año del alta de una unidad de cuidados intensivos en pacientes mayores de 65 años / Mortality and quality of life of patients beyond 65 years one year after ICU discharge

FUNDAMENTO: El tratamiento intensivo de los pacientes de más de 65 años es un tema controvertido, puesto que tienen una alta mortalidad y una esperanza de vida limitada. Sin embargo, debido al aumento de la longevidad cada día se tratan más pacientes en estas unidades, por lo que consumen una buen parte de sus recursos. Con este trabajo hemos querido conocer la mortalidad y calidad de vida (CDV), al año de alta de una unidad de cuidados intensivos (UCI), de los pacientes mayores de 65 años, y sus factores predictores. PACIENTES Y MÉTODO: Estudio retrospectivo de los pacientes de 65 años o más, ingresados en un UCI polivalente. Se analizan la mortalidad y la CDV al año del alta de la UCI (con el cuestionario EuroQOL modificado). Con objeto de conocer los factores predictores de mortalidad y CDV al año, se estimaron dos modelos de regresión logística múltiple. RESULTADOS: De los 313 pacientes estudiados, 95 (50 por ciento) fallecieron en la UCI, 32 (10 por ciento) en el hospital y 34 (11 por ciento) tras el alta. La disfunción orgánica (p < 0,0000; odds ratio [OR], 2,9), la afección respiratoria (p < 0,0000; OR, 0,15) y la cirugía cardíaca (p < 0,01; OR, 2,8) fueron los únicos factores predictores de mortalidad. De los 152 pacientes supervivientes al año, el 21 por ciento empeoraron la CDV que tenían previamente, y sólo el 17 por ciento de los pacientes eran incapaces de vivir de una forma independiente. Los predictores de CDV fueron la CDV previa (p < 0,0002; OR, 10,2) y la edad (p < 0,002; OR, 0,09). CONCLUSIÓN: A pesar de que la mortalidad al año fue alta (51 por ciento), el 83 por ciento de los supervivientes eran capaces de vivir independientemente. Dado que la mortalidad depende del desarrollo de disfunción multiorgánica durante la estancia en la UCI y no de la edad, ésta no puede ser el factor determinante de los cuidados (AU)