Trends in gastrointestinal bleeding in the Region of Valencia (2000-2005). Relationship to sales of nonsteroidal anti-inflammatory drugs and acid suppression medication

Objective Describe 2000-2005 time trends of prescription for NSAIDs, proton pump inhibitors (PPIs) and hospital admissions for gastrointestinal (GI) bleeding. Methods Time series analysis of gastrointestinal (GI) bleeding admission and drugs’ Defined Daily Dose per 1000 people per day (DDD/1000/day) in the Region of Valencia, Spain, from January 2000 to December 2005.ResultsDispensation of NSAIDs went from 42.7 DDD/1000 people/day in 2000 to 58.3 DDD/1000 people/day in 2005. During the same period, dispensation of PPIs went from 26.3 DDD/1000 people/day to 68.5 DDD/1000 people/day (both are statistically significant). The rate of hospitalisations for gastrointestinal bleeding during this period oscillated between 142 and 126 admission per 100 000 inhabitants/year. No year showed significant differences compared to 2000.ConclusionA substantial increase in the NSAID use from 2000 to 2005 was not accompanied by changes in GI bleeding hospitalisation rates in Valencia, but GI bleeding rates continued to be high, suggesting a need to improve NSAIDs use (AU)

Objetivo Describir las tendencias temporales durante el periodo 2000-2005 de la prescripción de AINE, inhibidores de la bomba de protones (IBP) y los ingresos hospitalarios por hemorragia gastrointestinal (GI).Métodos Análisis de series cronológicas de ingresos por hemorragia GI y de las dosis diarias definidas (DDD) de medicamento por cada 1.000 personas y día (DDD/1.000/día) en la Comunidad Valenciana desde enero de 2000 hasta diciembre de 2005.ResultadosLa dispensación de AINE ha aumentado desde 42,7 DDD/1.000/día en 2000 a 58,3 DDD/1.000/día, y la de IBP pasó de 26,3 DDD/1.000/día a 68,5 DDD/1000/día (ambos son cambios estadísticamente significativos). La tasa de ingresos por hemorragias GI durante este periodo pasó de 142 a 126 por cada 100.000 habitantes/año. En relación a 2000, ninguno de los años analizados muestra diferencias significativas. Conclusiones El aumento sustancial del uso de AINEs entre 2000 y 2005 no se vio acompañado de cambios en la tasa de ingresos hospitalarios en Valencia, pero la tasa de hemorragias GI siguieron siendo altas, lo que sugiere que es necesario mejorar la utilización de los AINE (AU)

Trends in gastrointestinal bleeding in the Region of Valencia (2000-2005). Relationship to sales of nonsteroidal anti-inflammatory drugs and acid suppression medication.

OBJECTIVE: To describe 2000-2005 time trends of prescription for NSAIDs, proton pump inhibitors (PPIs) and hospital admissions for gastrointestinal (GI) bleeding. METHODS: Time series analysis of gastrointestinal (GI) bleeding admission and drugs' Defined Daily Dose per 1000 people per day (DDD/1000/day) in the Region of Valencia, Spain, from January 2000 to December 2005. RESULTS: Dispensation of NSAIDs went from 42.7 DDD/1000 people/day in 2000 to 58.3 DDD/1000 people/day in 2005. During the same period, dispensation of PPIs went from 26.3 DDD/1000 people/day to 68.5 DDD/1000 people/day (both are statistically significant). The rate of hospitalisations for gastrointestinal bleeding during this period oscillated between 142 and 126 admission per 100 000 inhabitants/year. No year showed significant differences compared to 2000. CONCLUSION: A substantial increase in the NSAID use from 2000 to 2005 was not accompanied by changes in GI bleeding hospitalisation rates in Valencia, but GI bleeding rates continued to be high, suggesting a need to improve NSAIDs use.

[Interruption to treatment with combined lopinavir/ritonavir therapy in HIV positive patients]. / Interrupción del tratamiento con la terapia combinada lopinavir/ritonavir en pacientes VIH+.

OBJECTIVE: To describe the extent of interruptions to treatment with therapies which include the combination of lopinavir-ritonavir within the SNS (Spanish National Health System), as well as identify the causes of these interruptions and analyse the factors associated with the same. METHOD: Retrospective cohort of 197 seropositive patients, who began treatment with lopinavir-ritonavir between January 2000 and October 2002. The patients attended the outpatient pharmaceutical care unit and were followed-up until December 2002. Interruptions and their causes were identified and the factors associated with the interruption were analysed using proportional hazard models. RESULTS: The mean follow-up period was 263 days and 38.6% of patients interrupted therapy. The most common causes of interruption were intolerance (30.3%), non-compliance (21.1%) and therapy failure (5.26%). The mean treatment period was 487 days (95% CI: 432 to 542) and 50% of patients who interrupted treatment did so within the first 4 months. No associations were found between patient or treatment characteristics and the risk of interruption. CONCLUSIONS: The percentage of interruptions was lower than those in other observational studies, but greater than those in clinical trials. The significance of the causes of interruption was similar and no factor associated with the risk of interruption was found.

Interrupción del tratamiento con la terapia combinada lopinavir/ritonavir en pacientes VIH+ / No disponible

Objetivo: Describir, en el entorno del Sistema Nacional deSalud (SNS), la magnitud de la interrupción del tratamiento conterapias que incluyen la combinación lopinavir/ritonavir, identificarlas causas de estas interrupciones y analizar los factores asociadosa las mismas.Método: Cohorte retrospectiva de 197 pacientes seropositivosque iniciaron tratamiento con lopinavir/ritonavir entre enerode 2000 y octubre de 2002 en la unidad de atención farmacéuticaa pacientes externos, y fueron seguidos hasta diciembre de 2002.Se identificaron los casos de interrupción y sus causas y se analizaron,utilizando modelos de riesgos proporcionales, los factoresasociados a la interrupción.Resultados: La duración media de seguimiento fue de 263días. El 38,6% de los pacientes interrumpió el tratamiento, siendolas causas más frecuentes la intolerancia (30,3%), el incumplimiento(21,1%) y el fracaso terapéutico (5,26%). La mediana deduración del tratamiento fue de 487 días (IC95%: 432-542) y el50% de los casos que interrumpieron lo hicieron antes de4 meses. No se hallaron asociaciones entre características de lospacientes o del tratamiento y el riesgo de interrupción.Conclusiones: El porcentaje de interrupciones fue inferior alde otros estudios observacionales pero superior al de los ensayosclínicos. La importancia de las causas de interrupción fue similar.No se halló ningún factor asociado al riesgo de interrupción

Objective: To describe the extent of interruptions to treatmentwith therapies which include the combination of lopinavirritonavirwithin the SNS (Spanish National Health System), as wellas identify the causes of these interruptions and analyse the factorsassociated with the same.Method: Retrospective cohort of 197 seropositive patients,who began treatment with lopinavir-ritonavir between January2000 and October 2002. The patients attended the outpatientpharmaceutical care unit and were followed-up until December2002. Interruptions and their causes were identified and the factorsassociated with the interruption were analysed using proportionalhazard models.Results: The mean follow-up period was 263 days and38.6% of patients interrupted therapy. The most common causesof interruption were intolerance (30.3%), non-compliance(21.1%) and therapy failure (5.26%). The mean treatment periodwas 487 days (95% CI: 432 to 542) and 50% of patients whointerrupted treatment did so within the first 4 months. No associationswere found between patient or treatment characteristics andthe risk of interruption.Conclusions: The percentage of interruptions was lower thanthose in other observational studies, but greater than those in clinicaltrials. The significance of the causes of interruption was similarand no factor associated with the risk of interruption wasfound

Validez de la escala de cadera de Harris en la rehabilitación tras artroplastia de cadera / Validation of the Harris hip score in rehabilitation after hip arthroplasty

Antecedentes. El instrumento más utilizado para evaluar los resultados obtenidos tras artroplastia de cadera es la escala de cadera de Harris (Harris Hip Score, HHS) que, sin embargo, apenas cuenta con estudios de validez. El objetivo de este trabajo es analizar las propiedades clinimétricas de la HHS. Material y método. Cohorte prospectiva de 89 pacientes en tratamiento rehabilitador tras artroplastia de cadera, en los que se administró al inicio de la rehabilitación y a los 3 meses de seguimiento, la HHS y el Medical Outcomes Study-Short Form-36 (MOS SF-36). Se valoró la validez de contenido, de constructo, de criterio y la sensibilidad a los cambios de la HHS y sus subescalas. Resultados. La HHS no mostró efectos techo o suelo de importancia y sus puntuaciones se correlacionaron fuertemente con las dimensiones análogas del MOS SF-36, en particular con las de función física y dolor. Las diversas subescalas de la HHS y la puntuación total, mostraron diferencias significativas entre la evaluación basal y a los 3 meses (excepto la subescala de deformidad). Las dimensiones función física, dolor y rol funcional del MOS SF-36 mostraron un comportamiento similar. El tamaño del efecto fue elevado para la subescala de función y la puntuación global de la HHS, y moderado o pequeño para el resto. Las dimensiones función física, rol funcional y rol social del MOS SF-36 también mostraron un elevado tamaño del efecto. Conclusiones. La HHS es un instrumento válido y sensible a los cambios en pacientes en rehabilitación tras artroplastia de cadera

Background. The Harris Hip Score (HHS) is the most widely used instrument to measure results after hip arthroplasty. However, very few studies have been made to validate this tool. The aim of this study is to analyze the HHS clinimetric properties. Material and method. A prospective cohort of 89 patients in rehabilitation after hip arthroplasty in whom the HHS and the Medical Outcomes Study Survey Form-36 (MOS SF-36) were both administered at the beginning of rehabilitation and after three months. The content, construct and criteria validity, and responsiveness of the HHS and its subscores were analyzed. Results. The HHS did not show a significant ceiling or floor effect and it correlated strongly with the analogous dimensions of the MOS SF-36, particularly Physical Function and Pain. The different subscores and the overall score of the HHS showed significant differences between the basal evaluation and after three months (with the exception of Deformity). The Physical Function, Pain and Functional Role dimensions of the MOS SF-36 behaved similarly. The magnitude of the effect size was high for the Function subscore and the overall score, and moderate to small for the others. The Physical Function, Functional Role and Social Role dimensions of the MOS SF-36 showed similar behaviour. Conclusions. The HHS is a valid and responsive instrument in patients undergoing rehabilitation after hip arthroplasty

[Efficacy of electroconvulsive therapy: a systematic review of scientific evidences]. / Eficacia de la terapia electroconvulsiva: revisión sistemática de las evidencias científicas.

We carried out a systematic study of bibliographical review of scientific evidence provided by clinical trials that assessed the short, medium and long-term efficacy of electroconvulsive therapy (ECT) from 1965 until June 2003. The studies with the following features have been excluded: a) those in which ECT is not the aim of the research; b) those that do not compare ECT with another different treatment; c) those in which the aim of the research is not to evaluate the efficacy of ECT, and d) those in which the studies are not randomized clinical trials. We have used the biomedical databases Medline, Psyclit, IME and Cochrane. On applying the corresponding search strategies on every bibliographical repertory, a total amount of 916 studies were found, which were reduced to 62 after having applied the specified exclusion criteria. The scientific evidence obtained, which compare the efficacy of ECT exclusively in depression, schizophrenia, mania and Parkinson disease, are systematized.

Eficacia de la terapia electroconvulsiva: revisión sistemática de las evidencias científicas / Efficacy of electroconvulsive therapy: a systematic review of scientific evidences

Realizamos un estudio sistemático de revisión bibliográfica de las evidencias científicas proporcionadas por los ensayos clínicos que evalúan la eficacia de la terapia electroconvulsiva (TEC) a corto, medio y largo plazo desde el año 1965 hasta junio de 2003. Se excluyen los trabajos en los que: a) la TEC no es el objeto de la investigación; b) si no se compara la TEC con otro tratamiento distinto; c) cuando el objeto del estudio no es valorar la eficacia de la TEC, y d) cuando los estudios no son ensayos clínicos aleatorizados. Usamos las bases de datos biomédicas: Medline, Psyclit, Cochrane e IME. Al aplicar las correspondientes estrategias de búsqueda en cada uno de los repertorios se hallaron un total de 916 estudios, que se reducen a 62 tras aplicar a su vez los correspondientes criterios de exclusión especificados. Se sistematizan las evidencias científicas obtenidas, que comparan la eficacia de la TEC exclusivamente en depresión, esquizofrenia, manía y enfermedad de Parkinson (AU)

No disponible

[Emergency department utilization by children aged less than two years old]. / Utilización de los servicios de urgencias hospitalarios por niños menores de dos años.

BACKGROUND: Emergency department visits are rising although birth rate is decreasing. OBJECTIVE: To compare emergency department.(ED) utilization in the cohorts of children born in 1991 and 1996 in a health district. METHOD: We performed a two-year retrospective cohort study in the health district of Mieres (Spain). All children born in the health district in 1991 (n 600) and 1996 (n 423) were included. The number of visits to the ED was obtained and the frequency and mean number of visits in the first 2 years of life were calculated according to age, sex, and area of residence. RESULTS: The gross number of visits did not vary (1991: 852; 1996: 853), despite a decrease in birth rate. The number of children who attended the ED at least once increased by 34.8 % (1991, 60.6 %; 1996, 82 %) and the frequency of visits increased by 41.7 % (1991, 142.2 %; 1996, 201.4 %). More than 60 % of visits were made by 20 % (1991) of the children and by 29 % (1996). The percentage of children who attended the ED, the frequency rate and the mean number of visits were significantly higher in the municipality nearest the hospital than in the remaining municipalities in the health district. CONCLUSIONS: Although the gross number of visits to the ED remained unchanged, ED utilization increased substantially in only 5 years.

Utilización de los servicios de urgencias hospitalarios por niños menores de dos años / Emergency department utilization by children aged less than two years old

Antecedentes: Parece existir un incremento de las visitas en los servicios de urgencia hospitalarios (SUH), no homogéneo, en un contexto de disminución de la natalidad. Objetivo Comparar la utilización del SUH de las cohortes de niños nacidos en 1991 y 1996 en un área sanitaria. Método Estudio retrospectivo de cohortes con 2 años de seguimiento, en el área sanitaria de Mieres (Asturias). Se incluyen todos los niños nacidos en el área de salud en 1991 (n 600) y 1996 (n 423). Se mide el número de visitas realizadas al SUH y se calculan la tasa de visitas y promedio de visitas en los primeros 2 años, en función de la edad, sexo y municipio de residencia. Resultados El número bruto de visitas no varió (1991, 852; 1996, 853) pese a la disminución de nacimientos. El número de niños que acudió a urgencias al menos una vez se incrementó el 34,8 per cent (1991, 60,6 per cent; 1996, 82,0 per cent), y la frecuentación el 41,7 per cent (1991, 142,2 per cent; 1996, 201,4 per cent). El 20 per cent (1991) y el 29 per cent (1996) de los niños generaron más del 60 per cent de las visitas. En el municipio más cercano al hospital el porcentaje de niños que utilizó el SUH, la frecuentación y el promedio de visitas fue significativamente mayor que en el resto de los municipios. Conclusiones Aunque el número bruto de visitas permaneció estable, la utilización del SUH experimentó un importante crecimiento en 5 años (AU)

Evidence based educational outreach visits: effects on prescriptions of non-steroidal anti-inflammatory drugs.

AIMS: To evaluate the effectiveness of an evidence based group educational outreach visit on prescription patterns of non-steroidal anti-inflammatory drugs (NSAIDs) in primary care. DESIGN: Randomised controlled simple blind trial, with randomisation into three groups: experimental (evidence based educational outreach visit), placebo (conventional education session), and control (without intervention). SETTING: The 24 primary care centres of the National Institute of Healthcare Network in a rural province of Aragon, Spain. PARTICIPANTS: The 24 primary health care teams of the network, with 158 general practitioners (GPs). The teams were randomised into the groups, experimental (8 teams, 48 GPs), placebo (8 teams, 54 GPs), and control (8 teams, 56 GPs). INTERVENTION: Experimental group: one group educational outreach visit, conveying data based on a systematic review of the literature that was reinforced with printed material; placebo group: one non-structured educational session; control group: no intervention. Both educational sessions emphasised that there are no differences in the effectiveness of the NSAIDs reviewed (diclofenac, piroxicam, and tenoxicam); a recommendation was made to prescribe diclofenac over tenoxicam because of price differences. MAIN OUTCOME MEASURES: Changes in the number of packages prescribed for each of the drugs and changes in the cost per package of NSAIDs prescribed during the six months before, and after the intervention. RESULTS: There were no differences in the basal characteristics of the three groups, except for the number of prescriptions during the six months before the intervention. Prescriptions for NSAIDs decreased homogeneously in the three groups. For tenoxicam, the experimental group reduced prescriptions by 22.5% (95%CI: 34.42 to -10.76), compared with a reduction of 9.78% (95%CI: -17.70 to -1.86) in the placebo group and an increase of 14.44% (95%CI: 5.22 to 23.66) in the control group. The average cost per prescription decreased by 1.91% (95%CI: -0.33% to -3.49%) in the experimental group, 0.16% (95%CI: -0.27% to -2.93%) in the placebo group, and rose by 1.76% (95%CI: 0.35% to 3.17%) in the control group. CONCLUSIONS: Evidence based educational outreach visits are more effective than no intervention at all. Results suggest that evidence based educational outreach visits are incrementally more effective than conventional educational sessions, which in turn are more effective than no intervention at all.

[Variability in attitudes and use conditions of electroconvulsive therapy. Results of a preliminary study]. / Variabilidad en actitudes y condiciones de utilización de la terapia electroconvulsiva. Resultados de un estudio preliminar.

OBJECTIVE: Presenting the results of a pilot study on attitudes and use of ECT in Spain which was administrated to volunteers during a national congress of psychiatry. MATERIAL AND METHODS: A cross survey on a sample of psychiatrists (N= 125) which is not representative enough who attended the congress. A descriptive analysis of the outcomes is made. RESULTS AND CONCLUSIONS: There is a statistically significant association depending whether ECT is used in the work place or not. When it is used, there are 100% favorable attitudes. On the other hand, only 36% attitudes are favorable when ECT is not used in the work place. It is typically applied within a period of 8-10 treatment sessions, with a mean frequency of three times a week, performed by psychiatrists who treat with this technique less than 10 patients per year and using facilities within 1 to 5 years old. Maintenance ECT is unusual and it is only performed in monthly or fortnightly sessions. The commonest anesthetic agents are Propofol and Thiopental but this is unknown by 27.6% of the practitioners. The outcomes are contrasted with the consolidated guidelines on clinical practice of ECT.

Variabilidad en actitudes y condiciones de utilización de la terapia electroconvulsiva. Resultados de un estudio preliminar / Variability in attitudes and use conditions of electroconvulsive therapy. Results of a preliminary study

Objetivo: Presentar los resultados de una encuesta piloto sobre actitudes y utilización de la terapia electroconvulsiva (TEC) en España que se administró a voluntarios durante un congreso nacional de psiquiatría. Material y método: Encuesta trasversal a una muestra no suficientemente representativa de psiquiatras (N= 125) asistentes al congreso. Se hace un análisis descriptivo de los resultados. Resultados y conclusiones: Existe una asociación estadísticamente significativa en función de si en el centro de trabajo se aplica o no la TEC, con un 100 por ciento de actitudes favorables cuando en el centro se utiliza la técnica, frente a sólo el 36 por ciento en el caso contrario. Típicamente se aplica en 8-10 sesiones, con un promedio de tres por semana, ejecutada por psiquiatras que tratan con la técnica menos de 10 pacientes al año, y con equipos de entre uno y cinco años de antigüedad. La TEC de mantenimiento es inusual y se realiza en sesiones mensuales o quincenales. Los anestésicos mas utilizados son el propofol y el tiopental, pero el 27,6 por ciento lo desconoce. Se contrastan los resultados con las recomendaciones de guías consolidadas de práctica clínica sobre la TEC (AU)

Factores asociados a complicaciones, reingresos y otros episodios adversos en cirugía biliar / Factors associated with complications, readmissions and other adverse outcomes in biliary surgery

Objetivos. Describir los episodios adversos (complicaciones postoperatorias, mortalidad, reintervenciones y reingresos) tras la cirugía biliar y analizar las asociaciones entre estos resultados y determinadas características del paciente y del ingreso hospitalario. Material y métodos. Cohorte de 692 pacientes intervenidos de cirugía biliar -no oncológica- entre 1992 y 1996 en un hospital comarcal, en la que se registraron prospectivamente las complicaciones postoperatorias, las reintervenciones y otros resultados de interés, y se identificaron retrospectivamente los reingresos en el período de estudio. Además del análisis descriptivo y bivariante, se utilizó la regresión logística para valorar las asociaciones entre complicaciones y características de los pacientes, y un modelo de regresión de riesgos proporcionales respecto al riesgo de reingreso. Resultados. El 19,5 por ciento de los pacientes desarrolló alguna complicación posquirúrgica (herida: 6,9 por ciento; intraabdominales: 3,6 por ciento; insuficiencias orgánicas: 3,0 por ciento), un 0,7 por ciento fueron reintervenidos en el ingreso, un 1,4 por ciento requirieron ingreso en cuidados intensivos y el 0,6 por ciento fallecieron intrahospitalariamente. El 4,2 por ciento de los pacientes reingresaron en el servicio de cirugía, en el año siguiente a la intervención, por un problema relacionado con la cirugía previa, y un 1,7 por ciento por coledocolitiasis residual (en todo el período de seguimiento). Las complicaciones posquirúrgicas se asociaron al sexo masculino (OR: 1,69; p < 0,05), al ingreso urgente (OR: 2,09; p < 0,05), a la cirugía urgente (OR: 6,59; p < 0,05), a los procedimientos de colecistectomía abierta simple (OR: 2,56; p < 0,05) y cirugía de la vía biliar principal (OR: 3,53; p < 0,05) respecto a la colecistectomía laparoscópica. Los casos complicados duplicaron en cuanto a la estancia media a los no complicados. El reingreso relacionado con el episodio previo tan sólo se asoció con la presencia de complicaciones durante el ingreso (OR: 3,44; p < 0,001).Conclusiones. Las tasas de acontecimientos adversos en la serie analizada, similares a otras series publicadas, señalan la importancia de las complicaciones en esta enfermedad y su impacto sobre la estancia media y los reingresos. Aunque la mayor parte de los factores de riesgo identificados quedan fuera del control del cirujano, configuran un subgrupo de pacientes de alto riesgo en los que debería incrementarse la vigilancia (AU)

[Senior citizen health conditions and hospitalization on geriatric, general and surgical floors, a population study conducted in Toledo]. / Estado de salud de las personas ancianas y hospitalización en servicios geriátricos, médicos y quirúrgicos. Estudio poblacional en Toledo.

BACKGROUND: The health condition and some clinical aspects configure a group of senior citizens in need of further care who could benefit from specialized geriatric care, although no consensus exists as to how to identify these patients. The aim of this study is to describe the profile of those patients over 64 years of age who are hospitalized in a geriatric unit and to compare this profile to the senior citizens hospitalized in general medical and surgical units. METHOD: A cohort representative of the population over age 64 in the Judicial District of Toledo (n = 3214) was studied over an eighteen-month period for the purpose of identifying the income and length of stays at the public hospitals in the health care district in question. The health condition-related variables were gathered by means of personal interviews, and the income and the different aspects thereof by way of hospital admissions department data. RESULTS: A total of 410 individuals were admitted (12.8%), 168 patients (30.7%) in geriatrics, 204 (37.3%) in medical units and 174 (32.0%) in surgical units. In geriatrics, the average age was significantly higher (age 77.4), there being no differences in the average length of stay (12.8 days; CI 95%) 10.6-14.0), 44 patients (8.1%) having died, 26 (59.1%) hospitalized in geriatrics. More females, younger patients having minor vision and hearing impairments were admitted to the surgical units. In geriatrics, as compared to the medical units, more patients over 80 years of age, living in senior citizen living facilities, having no spouse, moderate-to-severe functional dependence, impaired cognitive function, depression, poor quality of life and scanty social resources. CONCLUSIONS: No differences were found to exist between the health conditions of those over age 64 who were hospitalized in non-surgical and surgical units. In geriatrics, as compared to the other groups of units, the patients were older, in worse condition, had a higher death rate and similar average length of stay.

¿Rehabilitar en el hospital o en unidades básicas extrahospitalarias? Un análisis de minimización de costes / Rehabilitation at the hospital or at basic extrahospital units? An analysis of costs minimization

Introducción: La búsqueda de una mayor eficiencia en el sector sanitario público debe de tender a una descentralización en la provisión de servicios. Desde esta óptica un elemento destacado a analizar son las diferencias de costes que pueden existir entre las consultas externas hospitalarias y la asistencia ambulatoria. Objetivo: Análisis de minimización de costes de la asistencia ofertada por un Servicio de Rehabilitación hospitalaria frente a la ofertada en un centro de atención primaria. Material y método: El estudio se ha realizado en el área 9 de la Comunidad Valenciana, que cuenta con un centro de rehabilitación hospitalaria y dos unidades básicas de rehabilitación. Se ha realizado el cálculo de los costes directos de cada centro: sueldos y salarios, consumos de material, mantenimiento y amortizaciones. Se ha desestimado la incorporación de costes estructurales al no encontrarse implantado un sistema de contabilidad analítica en atención primaria y por la posible distorsión en cuanto a resultados que su inclusión produciría. Se han utilizado las unidades relativas de valor para ponderar las diferentes actividades asistenciales que son comunes a todos los centros. Resultados: El coste medio por consulta médica obtenido es del 6.502 pesetas en la atención hospitalaria y 4.806 pesetas en la unidad básica de rehabilitación. Por otro lado, el coste de la unidad relativa de valor de físioterapia se sitúa entre 940 pesetas en el centro hospitalario y 491 pesetas en la unidad básica de rehabilitación. Conclusiones: Los costes de las actividades asistenciales son significativamente inferiores en la UBR, aunque los resultados obtenidos pudieran no ser extrapolables a otras áreas con diferente sistema organizativo (AU)

Ganancia funcional y calidad de vida en patología de partes blandas de hombro / Functional gain and quality of life in disorders of soft tissues of the shoulder

Antecedentes: El objetivo del estudio es valorar la ganancia funciona¡ y en calidad de vida de los pacientes con patología de partes blandas del hombro a los tres meses de seguimiento, y analizar la influencia de determinadas características de los pacientes y de su calidad de vida -valorada en la primera visita-en el resultado funciona¡ final. Material y método: Cohorte prospectiva de los 105 pacientes que acudieron a las unidades de rehabilitación del área 9 de la Comunidad Valenciana por patología de partes blandas del hombro en 1997-1998, en los que se valoró la capacidad funcional mediante la escala de Constant y la calidad de vida mediante el cuestionario Medical Outcomes Study Survey Form 36 (MOS SF36), en la primera visita y a los tres meses de seguimiento. Se analizaron las diferencias entre las dos administraciones de ambos instrumentos de medida y los factores asociados a la mejor puntuación final en la escala de Constant. Resultados: La puntuación global en la escala de Constant pasó de una media de 42,9 puntos en la valoración inicial a 63,2 en la final, siendo estadísticamente significativas las mejoras de todas las dimensiones de la escala. El MOS-SF36 mostró mejorías significativas en las dimensiones dolor, rol funcional y función l física, pero no en el resto de dimensiones. En el análisis bivariable entre características iniciales de los pacientes y resultado en la escala de Constant a los tres meses, ser hombre, poseer estudios universitarios, las mejores puntuaciones en la escala de Constant (excepto en dolor) y en las dimensiones función física, rol funcional, dolor, vitalidad y salud mental del MOS-SF36 se asociaron a mejores resultados funcionales. En el análisis multivariamente sólo el ser hombre, la movilidad activa y la salud mental se asociaron a mejores resultados funcionales. Conclusiones: Los pacientes con patología de partes blandas del hombro experimentan una mejora funcional y en parte de las dimensiones de calidad de vida. La mejora funcional se asocian al sexo (hombres), a la movilidad activa y la salud mental previas. (AU)

[Analysis of opinions, attitudes and knowledge of physicians of health centers of Valencia concerning efficacy and efficiency of drug prescriptions]. / Análisis de las opiniones, actitudes y conocimientos de los médicos de los centros de salud de Valencia sobre la eficacia y la eficiencia en la prescripción de medicamentos.

OBJECTIVE: To find the views, attitudes and knowledge of Primary Care doctors concerning the efficacy and efficiency of medical prescription. DESIGN: Descriptive, crossover study. SETTING: 10 Health Centres in the city of Valencia. PARTICIPANTS: The 115 doctors, both general and family practitioners, working at these centres. INTERVENTIONS: A survey gathered information on the doctors' views about the appropriateness of considering price when prescribing, on their assessment of ten strategies aimed at improving prescription efficiency, and their understanding of the efficacy and cost of certain medicines used in Primary Care. RESULTS: 1. 81% of those surveyed stated that prescription costs had to be considered at the moment of deciding patient treatment. 2. 70.4% of their opinions of the efficacy of medicines, as measured by the Intrinsic Therapeutic Value, were accurate. 3. 41% of the prices estimated by doctors were correct. There was a tendency to undervalue prices and to eliminate differences between products of identical composition. 4. In the area of strategies to improve prescription efficiency, doctors clearly favoured training strategies (prescription guidelines or in-work training) over strategies involving "assuming economic risks" (pharmacy self-management...).

[Nursing care in the home and in conventional hospitalization]. / Cuidados de enfermería en hospitalización a domicilio y hospitalización convencional.

BACKGROUND: Nursing care is of especial importance in hospital care in the home (HH). This is as due to the characteristics of the patient as it is to the transfer to the informal carers for the patient. The aim of this study is to analyse the quantity and type of nursing care administered and required by patients in HH and conventional hospitalisation (CH). METHODS: Project Research Nursing (PRN) was used to quantify the amount and types of nursing care administered and required in 2 groups of patients (HH: 148 patients, 1776 stays; CH: 148 patients, 1113 stays) having similar characteristics and treated in each way, together with how they evolved, analysing differences in terms of forms of attention and the characteristics of the patients. RESULTS: In terms of the care administered, those patients in HH (647.8 minutes/episode) received less care than those in CH (1030 minutes/episode). This difference was fundamentally due to the fact that they received less basic care (HH: 96.6 min./episode; CH: 464.3 min./episode) and diagnostic work (HH: 84.4 min./episode; CH: 177.3). On the other hand, patients in HH received a greater quantity of communicational care (238.8 min., as opposed to 107.4 in CH). No significant differences were found between the care administered and that which was required. CONCLUSIONS: Patients in HH received less nursing care than did those in CH, mainly due to the fact that they received less basic care from nurses, as this work was transferred to their careers. They also received less care associated with diagnostic tests (depending on styles of medical practice), although they received more care in the form of communication (health education). The lack of differences between the care that was actually administered and that which was required suggests that the quality of care provided is sufficient in both forms of hospitalisation.

[Factors determining costs of drug prescriptions in primary health care]. / Factores determinantes del gasto por prescripción farmacéutica en atención primaria.

OBJECTIVE: To describe and explain the annual pharmaceutical expenditure generated by the professionals in a Health Area. DESIGN: An observational crossover study. SETTING: Primary Care. Doctors in a Health Area. PARTICIPANTS: 99 general practitioners who worked during 1992 in Area 3, Castellón. INTERVENTIONS: We used as a variable reply the pharmaceutical expenditure of each doctor during 1992, the expenditure per inhabitant and the expenditure per inhabitant standardised for the percentage of passives. We gathered as explanatory variables of the same: age, gender, whether the post was provisional or permanent, rural or urban area, MIR (resident) training or not, the model of Primary Care, frequency of attendance, whether the doctors worked there exclusively, the number of pensioners and the number of patients at work registered. MEASUREMENTS AND RESULTS: In the bivariant analysis we found a significant association of expenditure with being provisional in the post, the old model of primary care, an urban area, greater age of the doctor, greater frequency of attendance, non-exclusivity and the number of patients registered. These associations varied in line with the variable reply used. In the different models of multiple linear regression obtained, the influence of the number, non-exclusivity, gender and work-place characteristics predominated. CONCLUSIONS: Greater pharmaceutical expenditure appears to be related to the number of patients registered, the absence of exclusivity, doctors being women and the features of the town where they work.