Incidence of hypercalcemia, hypercalciuria and related factors in patients treated with recombinant human parathyroid hormone (1-84).

AIM: The aim of this paper was to determine the incidence of hypercalcemia and hypercalciuria (and related factors) in 22 postmenopausal women with osteoporosis treated with PTH (1-84) in daily practice. METHODS: Osteoporosis was defined as history of osteoporotic fracture or a T score less than -3 SD on bone densitometry. Patients were treated with PTH (1-84), 100 mcg/daily, for 12 months. Clinical and laboratory data at baseline and after 6 months of treatment were assessed. RESULTS: The mean age was 71.9 years. The incidence of hypercalcemia and the hypercalciuria were 6 events. Increase in serum calcium levels showed a statistically significant correlation with 24-hour urinary calcium (rho [ρ]=0.83, P<0.001), serum alkaline phosphatase (ρ=0.76, P=0.001), total proteins (ρ=0.77, P=0.005), and ß-CTx (ρ=0.82, P=0.002). On the other hand, 24-hour urinary calcium excretion correlated significantly with ß-CTx (ρ=0.83, P=0.002), alkaline phosphatase (ρ=0.73, P=0.005), total proteins (ρ=0.73, P=0.02), and serum phosphate (ρ=0.58, P=0.04). When the group of patients with and without hypercalcemia were compared, there were statistically significant differences in increases of ß-CTx and baseline ß-CTx values, whereas the group of patients with and without hypercalciuria showed significant differences in serum calcium increases and baseline values of T score at the femoral neck. CONCLUSION: The incidence of hypercalcemia and hypercalciuria after treatment with PTH (1-84) is similar to that expected according to the product's technical specifications. There was a significant correlation between increases of serum calcium, urinary calcium excretion, serum alkaline phosphatase, and ß-CTx after treatment with PTH (1-84). Baseline ß-CTx values were significantly lower in patients who developed hypercalcemia than in those with normal serum calcium levels.

Unidad de gestión clínica de rehabilitación y aparato locomotor: una nueva propuesta de gestión / Clinical management and unity of rehabilitation and locomotive apparatus (CMU-LA): a new management proposal

Introducción. En el siglo Xxi la mayor amenaza, probablemente, con la que se enfrentan los sistemas sanitarios es el incremento continuado del gasto, producido por el aumento en las expectativas en salud y una mayor calidad y esperanza de vida de la población. Esto obliga a incorporar nuevas herramientas de gestión a la práctica clínica. El objetivo de este trabajo es presentar el acuerdo de gestión de una unidad de gestión clínica del aparato locomotor y rehabilitación (UGC-AL). Material y métodos. La UGC-AL está compuesta por 18 personas que integran tres especialidades relacionadas con la patología del aparato locomotor para dar respuesta a las necesidades de la población del área sanitaria correspondiente, siguiendo el modelo de excelencia de la calidad. Resultados. El acuerdo de gestión de la UGC-AL consta de 10 dimensiones con 28 objetivos. El mismo recoge, entre otras, las dimensiones siguientes: accesibilidad, normas de calidad de los procesos asistenciales integrados, orientación al ciudadano, continuidad asistencial y disminución de la variabilidad clínica. Conclusión. Desde su creación, la UGC-AL se constituye como única “puerta de entrada” al sistema de todos los pacientes con patología no quirúrgica del aparato locomotor, mejorando la accesibilidad, aumentando la actividad clínica, disminuyendo la demora, facilitando la continuidad asistencial, para mejorar la calidad y seguridad del paciente, disminuyendo la variabilidad en la práctica clínica (DVPC) (AU)

Background. The continuous rise in costs cost, due to the increase of the expectations in health care and greater quality and life expectancy of the population, is probably the main threat faced by the health care systems in the Xxi century. Thus, new management tools must be incorporated into the clinical practice. The aim of this work is to present the care management agreement of a Clinical Management Unit in Locomotive Apparatus and Rehabilitation (CMU-LA). Methods. The CMU-LA is formed by 18 people from three specialties related with Locomotive Apparatus disease who use the excellence in quality model to satisfy the needs of the population of the corresponding Health Care Area. Results. The care management agreement of the CMU-LA has of 10 dimensions with 28 objectives. This agreement includes the following dimensions: Accessibility, Quality standards for integrated welfare processes, Citizen Guidance, Continuity of care, Decrease of the clinical variability. Conclusions. Since its creation, the CMU-LA is the only entry point for patients having Locomotive Apparatus problems that do not require surgery. It creation has led to improvement in accessibility, an increase in clinical activity, a reduction of the delay, and thus it has favored care continuity in order to improve the quality and safety of the patient, diminishing variability in the clinical practice (AU)