Impact of severe aortic stenosis on quality of life.

INTRODUCTION: Among individuals ≥ 65 years old, aortic stenosis is highly prevalent and the number of cases is expected to increase in the coming decades, due to the increased life expectancy. Nevertheless, the actual aortic stenosis burden is not well known in population settings and the impact of aortic stenosis on quality of life has not been studied. The aim of this study was to evaluate aortic stenosis impact on health-related quality of life in patients > 65 years old. METHODS: An epidemiological case-control study was carried out to compare quality of life in patients ≥65 years old with severe symptomatic aortic stenosis. Demographical and clinical information was prospectively obtained and quality of life information was collected with the Short Form Health Survey_v2 (SF-12) questionnaire. The association between quality of life and aortic stenosis was determined using multiple logistic regression models. RESULTS: Patients with severe aortic stenosis self-perceived worse quality of life on all dimensions and summary components of the SF-12 questionnaire. In the final multiple logistic regression model a significant inverse association was observed between the dimensions 'physical role' and 'social role' (p = 0.002 and p = 0.005) and an association close to significance with 'physical role' (p = 0.052) of the SF-12 questionnaire. CONCLUSION: The use of quality of life scales allows the assessment of the impact of aortic stenosis on quality of life and may improve the therapeutic approach to severe aortic stenosis, providing evidence for patient-centered care.

A retrospective HEART risk score comparation of acute non-traumatic chest pain patients in an emergency department in Spain.

Non traumatic chest pain is the second most common cause of attention at the Emergency Departments (ED). The objective is to compare the effectiveness of HEART risk score and the risk of having a Major Adverse Cardiovascular Event (MACE) during the following 6 weeks in 'Acute Non-traumatic Chest Pain' (ANTCP) patients of an ED in Lleida (Spain). The ANTCP patient cohort was defined using medical data from January 2015 to January 2016. A retrospective study was performed among 300 ANTCP patients. Diagnostic accuracy to predict MACE, HEART risk score effectiveness and patient risk stratification were analysed on the ANTCP Cohort. HEART risk score was conducted on ANTCP Cohort data and patients were stratified as low-risk (n = 116, 38.7%), moderate-risk (n = 164, 54.7%) and high-risk (n = 20, 6.7%); differently from the assessment performed by 'Current Emergency Department Guidelines' (CEDG) on the same patients: low risk and discharge (n = 56, 18.7%), medium risk and need of complementary tests (n = 137, 45.7%) and high risk and hospital admission (n = 107, 35.7%).The incidence of MACE was 2.5%, 20.7% and 100% in low, moderate and high-risk, respectively. Discrimination and accuracy indexes were moderate (AUC = 0.73, 95% confidence interval: 0.67-0.80). Clustering moderate-high risk groups by MACE incidence showed an 89.5% of sensitivity. Data obtained from this study suggests that HEART risk score stratified better 'acute non-traumatic chest pain' (ANTCP) patients in an Emergency Department (ED) compared with 'Current Emergency Department Guidelines' (CEDG) at the Hospital Universitari Arnau de Vilanova (HUAV). HEART score would reduce the number of subsequent consultations, unnecessary admissions and complementary tests.Trial registration: Retrospectively registered.

Análisis poblacional de la prescripción potencialmente inadecuada en ancianos según criterios STOPP/START (estudio STARTREC) / Potentially inappropriate prescribing in older Spanish population according to STOPP/START criteria (STARTREC study)

OBJETIVO: Racionalizar la prescripción en la población anciana es una prioridad de los sistemas sanitarios. Los criterios STOPP/START permiten detectar la prescripción potencialmente inadecuada (PPI) a nivel individual. Su aplicación a nivel poblacional permite determinar la prevalencia de PPI y su relación con diversas variables del paciente y del sistema sanitario. El objetivo de este estudio es analizar la prevalencia de PPI en población anciana a partir de bases de datos clínicos y de farmacia. DISEÑO: Estudio descriptivo transversal. Emplazamiento: Ámbito de atención primaria de la Región Sanitaria de Lleida, España. PARTICIPANTES: Se incluyen 45.408 pacientes de 70 años o más atendidos en los centros de salud como mínimo una vez en el último año. Mediciones principales: Se calcula la frecuencia de incumplimiento de 43 indicadores STOPP y 12 indicadores START, a partir de los fármacos prescritos durante un año y se ajustan modelos de regresión logística para evaluar su asociación con diversas variables. RESULTADOS: El 58% son mujeres. La edad media es de 79,7 años. El 58,1% incumplen como mínimo un criterio STOPP y/o START, relacionados principalmente con el uso de benzodiacepinas, antiinflamatorios no esteroideos e inhibidores de la bomba de protones por exceso, y los tratamientos para la osteoporosis, antiagregantes, estatinas, metformina y betabloqueantes por omisión. La PPI aumenta con la edad y la polifarmacia y es superior en pacientes ingresados en centros geriátricos y domiciliarios que en los ambulatorios. CONCLUSIONES: Los criterios STOPP/START identifican PPI en más de la mitad de pacientes ancianos de una región sanitaria española

OBJECTIVE: Rational prescribing in older people is a priority for health care organizations. The STOPP/START screening tool has been developed to identify potentially inappropriate prescribing (PIP) in individuals. In a primary care setting, STOPP/START can estimate PIP prevalence and related factors at population level. The aim of this study is to measure the prevalence rates of PPI in elderly population using clinical and prescription claim databases. DESIGN: Cross-sectional population study. Settings: Primary Care, Lleida Health Region, Spain. PARTICIPANTS: 45.408 patients 70 years old and over, attended in the primary health care centers at least once the last year. METHODS: 43 STOPP and 12 START criteria are applied to their 2012 clinical and prescription records. Logistic regression models are adjusted to determine PIP association with several factors. RESULTS: 45,408 patients are included. The mean age is 79.7 years, 58% being female. The overall prevalence of PPI is 58.1%. According to STOPP, the most common drugs identified are benzodiazepines, non-steroidal anti-inflammatory drugs and proton pump inhibitors; according to START, osteoporosis treatments, antiplatelet agents, statins, metformin and beta blockers. PIP increases with age and polypharmacy and it is higher in long-term care facilities residents and patients receiving home health care. CONCLUSIONS: In our Health Region, at least 50% of the population aged 70 or older has one or more PIP, according to STOPP/START criteria

[Potentially inappropriate prescribing in older Spanish population according to STOPP/START criteria (STARTREC study)]. / Análisis poblacional de la prescripción potencialmente inadecuada en ancianos según criterios STOPP/START (estudio STARTREC).

OBJECTIVE: Rational prescribing in older people is a priority for health care organizations. The STOPP/START screening tool has been developed to identify potentially inappropriate prescribing (PIP) in individuals. In a primary care setting, STOPP/START can estimate PIP prevalence and related factors at population level. The aim of this study is to measure the prevalence rates of PPI in elderly population using clinical and prescription claim databases. DESIGN: Cross-sectional population study. SETTINGS: Primary Care, Lleida Health Region, Spain. PARTICIPANTS: 45.408 patients 70 years old and over, attended in the primary health care centers at least once the last year. METHODS: 43 STOPP and 12 START criteria are applied to their 2012 clinical and prescription records. Logistic regression models are adjusted to determine PIP association with several factors. RESULTS: 45,408 patients are included. The mean age is 79.7 years, 58% being female. The overall prevalence of PPI is 58.1%. According to STOPP, the most common drugs identified are benzodiazepines, non-steroidal anti-inflammatory drugs and proton pump inhibitors; according to START, osteoporosis treatments, antiplatelet agents, statins, metformin and beta blockers. PIP increases with age and polypharmacy and it is higher in long-term care facilities residents and patients receiving home health care. CONCLUSIONS: In our Health Region, at least 50% of the population aged 70 or older has one or more PIP, according to STOPP/START criteria.

Association between Sick Leave Prescribing Practices and Physician Burnout and Empathy.

OBJECTIVES: To investigate the association between sick leave prescription and physician burnout and empathy in a primary care health district in Lleida, Spain. METHODS: This descriptive study included 108 primary care doctors from 22 primary care centers in Lleida in 2014 (183,600 patients). Burnout was measured with the Maslach Burnout Inventory and empathy with the Jefferson Scale of Physician Empathy. The reliability of the instruments was measured by calculating Cronbach's alpha and normal distribution was analyzed using the Kolmogorov-Smirnov-Lilliefors and χ2 tests. Burnout and empathy scores were analyzed by age, sex, and place of work (urban vs rural). Sick leave data were obtained from the Catalan Health Institute. RESULTS: High empathy was significantly associated with low burnout. Neither empathy nor burnout were significantly associated with sick leave prescription. CONCLUSION: Sick leave prescription by physicians is not associated with physicians' empathy or burnout and may mostly depend on prescribing guidelines.

Competencia del estudiante de medicina para respetar las creencias y la cultura del paciente / Racial stereotyping and cultural competence: improving medical education

Introducción: Las desigualdades en salud son injustas, innecesarias y evitables. La etapa de educación médica del grado es una oportunidad ideal para reflexionar en las prácticas y poder desarrollar habilidades y actitudes médicas basadas en el respeto, la equidad y la ecuanimidad de los futuros profesionales de la salud. Aprovechando la mejora del plan de estudios de nuestra facultad, diseñamos el presente estudio para comprobar si los estudiantes de medicina propondrían diferentes enfoques de la gestión del mismo hipotético caso clínico en función de la etnia del paciente. Sujetos y métodos: Primera etapa: comparación de las respuestas de los dos grupos de alumnos a un cuestionario sobre un caso clínico hipotético; la única variable discriminatoria entre los grupos fue la fotografía del paciente que se adjuntó: un joven negro en un caso, y un joven blanco, en el otro. Segunda etapa: el trabajo en casa y en una sesión de feedback. Tercera etapa: en grupos pequeños se realizó un taller centrado en el tema con actividades de sensibilización del problema. Resultados: Cuando el paciente era negro, se solicitaban un menor número de pruebas, el paciente tenía menos probabilidades de ser enviado a un hospital y había una percepción de que tendía a exagerar los síntomas para obtener un beneficio personal. Conclusiones: Se encuentran diferencias en el tratamiento del paciente por los estudiantes de medicina. Estamos a favor de la incorporación de los conceptos de las desigualdades en salud y la competencia cultural en los estudios de medicina, con el fin de minimizar el efecto de estas ideas preconcebidas desde el inicio de la formación de los futuros profesionales de la salud

Introduction: Health inequalities are multiple and complex and they are avoidable. Educating Medical student training is an ideal opportunity for reflecting on practices and for engendering skills and attitudes of respect, equity and equanimity among future health professionals. Coinciding with a modification of the teaching program at our faculty, we designed the present study to ascertain whether second-year medical students might propose different approaches to the management of the same hypothetical clinical case depending on the patient's ethnicity. Subjects and methods: 1st stage: comparison of the responses of two groups of students to a questionnaire regarding a hypothetical clinical case. The only discriminatory variable between the groups was the photograph of the patient attached: a black youth in one case, and a white youth in the other. 2nd stage: homework and in a feedback session. 3rd stage: small-group workshop focused on the need for retraining and activities to heighten awareness of the problem. Results: When the patient was black, fewer tests were requested, the patient was less likely to be sent to hospital, and there was a perception that he tended to exaggerate the symptoms to obtain personal benefit. Conclusions: We found prejudice in patient management at the beginning of the medicine degree. We advocate the incorporation of concepts of health inequalities and cultural competence in medical studies, so as to minimize the effect of these preconceived ideas from the very beginning of the training of future health professionals