Impact of Advanced Diabetes Centers on the healthcare experience of patients with type 2 diabetes using the IEXPAC tool.

AIMS: To determine the experience with healthcare among patients with type 2 diabetes according to the assistance model provided in their primary care centers, and to determine factors related with their experience. METHODS: This was a cross-sectional study performed in patients with type 2 diabetes with cardiovascular or renal complications. The patients were divided in two groups according to whether they had been attended in Advanced Diabetes centers (ADC) or the traditional assistance centers. Patient's healthcare experience was assessed with the "Instrument for Evaluation of the Experience of Chronic Patients" (IEXPAC) questionnaire, with possible scores ranging from 0 (worst experience) to 10 (best experience). RESULTS: A total of 451 patients (215 from ADC and 236 from traditional assistance centers) were included. The mean overall IEXPAC scores were 5.9 ±â€¯1.7 (ADC) and 6.0 ±â€¯1.9 (traditional assistance centers; p = 0.82). In the multivariant analyses, in ADC, the regular follow-up by the same physician (p = 0.01) and follow-up by a nurse (p = 0.01), were associated with a better patient experience, whereas receiving a higher number of medications with a worse patient experience (p = 0.04). In the traditional assistance centers, only the regular follow-up by the same physician was associated with a better experience (p = 0.02). Patients from ADC centers reported a higher score in the quality of life scale (69.1 ±â€¯16.5 vs 64.6 ±â€¯17.5; p = 0.008). CONCLUSIONS: In general, the healthcare experience of type 2 diabetic patients with their sanitary assistance can be improved. Patients from ADC centers report a higher score in the quality of life scale.

Healthcare experience among patients with type 2 diabetes: A cross-sectional survey using the IEXPAC tool.

Aim: To assess the experience with health care among patients with type 2 diabetes (T2DM) and to evaluate patients' demographic variables and healthcare-related characteristics which may affect their experience. Methods: A cross-sectional survey was delivered to T2DM adults. Patient experiences were assessed with the 'Instrument for Evaluation of the Experience of Chronic Patients' (IEXPAC) questionnaire, a validated 12-item survey, which describes patient experience within the last 6 months (items 1-11) and hospitalization in the last 3 years (item 12), with possible scores ranging from 0 (worst) to 10 (best experience). Results: A total of 451 T2DM patients responded to the survey (response rate 72.3%; mean age 69.5 ± 10.1 years, 67.8% men). The mean overall IEXPAC score was 5.92 ± 1.80. Mean scores were higher for productive interactions (7.92 ± 2.15) and self-management (7.08 ± 2.27) than for new relational model (1.72 ± 2.01). Only 32.8% of patients who had been hospitalized in the past 3 years reported having received a follow-up call or visit after discharge. Multivariate analyses identified that regular follow-up by the same physician and follow-up by a nurse were associated with a better patient experience. Continuity of healthcare score was higher only in those patients requiring help from others. Conclusions: The areas of T2DM care which may need to be addressed to ensure better patient experience are use of the Internet, new technologies and social resources for patient information and interaction with healthcare professionals, closer follow-up after hospitalization, and a comprehensive multidisciplinary approach with regular follow-up by the same physician and a nurse.

Impact of diabetes mellitus on the risk of severe exacerbation in patients with chronic obstructive pulmonary disease.

INTRODUCTION: Suffering type 2 diabetes mellitus (T2DM) appears to promote the occurrence of respiratory infections. However, studies to evaluate the risk of hospital admission due to exacerbations in patients with chronic obstructive pulmonary disease (COPD) and concomitant T2DM are scarce. MATERIALS AND METHODS: Prospective, observational study with a maximum follow-up of 18 months. Information on lung function, body mass index, degree of dyspnea, number of exacerbations, comorbidities and pneumococcal vaccination was obtained. Patients were classified into the categories COPD with (COPD/+T2DM) and without T2DM (COPD/-T2DM). RESULTS: A total of 121 patients with COPD were enrolled. Forty-seven (38%) of the study participants were diabetic. The presence of T2DM increased the risk of hospital admission due to COPD exacerbation (OR 2.66; P = 0.031), but no significant difference in the total number of exacerbations was detected. CONCLUSIONS: The risk of hospital admission in the course of exacerbation seems to be higher in COPD/+T2DM patients than in COPD/-T2DM subjects.

Niveles de concordancia interobservador de las escalas Norton y Braden en cuidados críticos / Interobserver concordance degrees in Norton and Braden scales for critical care

Objetivo: analizar la fiabilidad interobservador de cada uno de los ítems que componen las escalas Norton y Braden cuando se utilizan en cuidados intensivos. Material y método: estudio descriptivo multicéntrico en las Unida desde Cuidados Intensivos (UCI) de dos hospitales de Granada, con dos observadores en el Hospital Universitario Virgen de las Nieves (HUVN) y tres en el Hospital Universitario San Cecilio (HUSC) de Granada. Se seleccionaron268 pacientes en HUSC y 215 en HUVN, teniendo en cuenta una proporción de acuerdo esperada de 0,65 y una seguridad del 95%. Para el cálculo de la fiabilidad interobservador se utilizó el coeficiente de Kappa(dos observadores) y Kappa Fleiss (tres observadores). Se calcularon intervalos de confianza para un 95% de seguridad (IC 95%).Resultados: la fiabilidad total interobservador fue Muy Buena para ambas escalas: k= 0,8196 (IC 95%: 0,7350-0,901) para la escala Norton yk= 0,90 (IC 95%: 0,858-0,940) para Braden. En la escala de Norton los ítems Estado Físico e Incontinencia presentaron concordancias Moderada y Débil, el resto entre Buenas-Muy Buenas. En la escala de Braden, elítem Riesgo de Lesiones mostró concordancia Pobre (en HUVN) y Buena(en HUSC); el resto entre Moderadas-Muy buenas. Conclusiones: en ambos centros el ítem Estado físico muestra menos concordancia para la escala Norton. Para la Braden destaca el nivel de Pobre para Riesgo de Lesiones solamente en el centro sanitario que no se usaba habitualmente (menor nivel entrenamiento). La fiabilidad interobservador total de las escalas es mucho mayor que por ítems porque estas estratifican los riesgos (AU)

Objective: to analyze the interobserver reliability of each of the items included in the Norton and Braden Scales, when used in intensive care. Materials and method: multicenter descriptive study in the Intensive Care Units (ICUs) of two hospitals in Granada, with two observers in the Hospital Universitario Virgen de las Nieves (HUVN), and three in the Hospital Universitario San Cecilio (HUSC) in Granada. There was a selection of268 patients in HUSC and 215 in HUVN, taking into account an expected0.65 proportion of agreement, and a 95% safety. The Kappa coefficient was used (two observers) in order to calculate interobserver reliability, aswell as the Kappa Fleiss (three observers). Confidence intervals were calculated for 95% safety (CI 95%).Results: total interobserver reliability was Very Good for both scales: k=0.8196 (CI 95%: 0.7350-0.901) for the Norton Scale and k=0.90 (CI95%: 0.858-0.940) for Braden. Within the Norton Scale, the items Physical Condition and Incontinence showed Moderate and Weak concordances, while the rest ranged between Good- Very Good. Within the Braden Scale, the item Risk of Lesions showed Poor (in HUVN) and Good concordance (in HUSC); the rest ranged between Moderate-Very Good. Conclusions: in both centers, the item Physical Condition shows lower concordance for the Norton Scale. In terms of the Braden Scale, Poor concordance for Risk of Lesions is noticeable only in that health centre where it was not typically used (lower training level).The total interobserver reliability of scales is higher than per items, because there is risk stratification in scales (AU)

Sensitivity to bee venom antigen phospholipase A2: association with specific HLA class I and class II alleles and haplotypes in beekeepers and allergic patients.

Bee venom hypersensitivity is a clinical entity of outstanding importance because bee stings are a leading cause of mortality worldwide. Individuals with immediate-type bee venom hypersensitivity, beekeepers, and healthy controls were examined for HLA-DRB1, DQB1, and DQA1 alleles by sequence-specific oligonucleotide probe typing. Defined hypersensitivity to bee venom antigen phospholipase A2 (vbPLA2) is significantly associated with the presence of susceptible HLA class II alleles: DRB1*0101 (RR = 2.7, p < 3 x 10(-3)), DRB1*0103 (RR = 21.2, p < 7.5 x 10(-11)), DQA1*0101 (RR = 1.2, p < 38.52 x 10(-10)), and DQB1*0501 (RR = 4, p < 2.18 x 10(-10)). Some HLA class I alleles were also associated with risk to bee venom allergy: A*01 (RR = 2.4, p < 7.5 x 10(-4)), B*57 (RR = 35.1, p < 3.5 x 10(-7)), and B*5901 (p < 3.5 x 10(-5)), but they are probably of secondary significance. Three- (DRB1*0103-DQA1*0101-DQB1*0501) (RR = 21.24, p < 7.5 x 10(-11)) and five-loci (A*01-B*59-DRB1*0103-DQA1*0101-DQB1*0501) (p < 2.3 x 10(-6)) extended haplotypes are also significantly carried by vbPLA2 allergic patients. When HLA allele frequencies from patients are compared with those from beekeepers, only HLA-DRB1*0103 (RR = 11.7, p < 8.5 x 10(-5)) and HLA-DQA1*0101 (p < 0.02) were significantly increased in the former. These observations emphasize the importance of the DRB1*0103-DQA1*0101-DQB1*0501 haplotype as a strong candidate for susceptibility to vbPLA2 hypersensitivity, at least in our region.