Carme Carrion

Theoretical Impact on Coronary Disease of Using a Computerized Clinical Decision Support System in the Prescription of Lipid-lowering Treatment

in vascular risk. The objective of the present study was to assess the theoretical impact on the frequency of coronary artery disease of using the HTE-DLP throughout Spain with the CASSANDRAREGICOR methodology. The CASSANDRA-REGICOR system permits an estimate of the number of fatal and nonfatal coronary events that would occur in the Spanish population in the next 10 years in different scenarios according to trends in prevalence of cardiovascular risk factors. The system uses incidence data on coronary disease and risk factor prevalence from the REGICOR study. Extrapolation to Spain is based on data from the IBERICA study (incidence) and the DARIOS study (risk factor prevalence). The number of coronary events was predicted for 2010 to 2020 in patients aged between 35 and 75 years old. Population projections were provided by the Catalan Statistics Institute (IDESCAT) and Spanish National Statistics Institute (INE). The application enables an assessment of the 4 MedD, as key elements for the superior efficacy of this diet compared with a low-fat diet. It is likely that the MedD will be clearly reinforced as an intervention to be included in nonpharmacological treatment for preventing cardiovascular disease, thanks to the possibility of new studies backing the results published by de Lorgeril et al. The data from this study show that a majority of patients with CAD (63%) had acceptable adherence to the MedD. The application of the MEDAS–14 screener makes it possible to identify which aspects require improvement and provides the opportunity to focus and adapt a dietary intervention.

The use of clinical practice guidelines in primary care: professional mindlines and control mechanisms

OBJECTIVE To identify the relevant barriers and enablers perceived by primary care professionals in implementing the recommendations of clinical practice guidelines (CPG). METHODS Two focus groups were conducted with primary care physicians and nurses in Catalonia (Spain) between October and December 2012. Thirty-nine health professionals were selected based on their knowledge and daily use of CPG. Finally, eight general practitioners and eight nurses were included in the discussion groups. Participants were asked to share their views and beliefs on the accessibility of CPG, their knowledge and use of these documents, the content and format of CPG, dissemination strategy, training, professional-patient relationship, and the use of CPG by the management structure. We recorded and transcribed the content verbatim and analysed the data using qualitative analysis techniques. RESULTS Physicians believed that, overall, CPG were of little practical use and frequently referred to them as a largely bureaucratic management control instrument that threatened their professional autonomy. In contrast, nurses believed that CPG were rather helpful tools in their day-to-day practice, although they would like them to be more sensitive to the current role of nurses. Both groups believed that CPG did not provide a response to most of the decisions they faced in the primary care setting. CONCLUSIONS Compliance with CPG recommendations would be improved if these documents were brief, non-compulsory, not cost-containment oriented, more based on nursing care models, sensitive to the specific needs of primary care patients, and integrated into the computer workstation.

Análisis de la Validez de Contenido de un Cuestionario de Evaluación del Aprendizaje Basado en Problemas: Un Enfoque Cualitativo

The aim of this study is to analyze the validity of the content included in a standardized questionnaire used to evaluate components related to professional values and attitudes during Problem-Based Learning (PBL) sessions. PBL is a well-established learning method used in the medical sciences of the School of Medicine of the University of Girona (Spain) and is currently included in its curriculum. The validity of the content of the instrument was determined by posing open-ended questions to seven experts. A qualitative analysis of the experts’ opinions revealed the items that are relevant for evaluating the professional training of medical students. The questionnaire appears to be a valid tool for evaluating the professional values analyzed during PBL sessions. Fourteen of the twenty items are relevant. To improve the content validity of the questionnaire, three new items should be added: student autonomy, using appropriate nonverbal language, and capacity of controlling emotions.

Cognitive Therapy for Dementia Patients: A Systematic Review

Background: Cognitive therapy is a well-established intervention for treating elderly suffering from dementia. In particular, reality orientation and skills training seem to be effective interventions for reversing cognitive impairment among elderly, although findings are inconclusive. Therefore, a systematic update of the existing evidence of cognitive therapy for people suffering from dementia is needed. Aim: To review existing scientific evidence regarding the efficacy of cognitive therapies for elderly suffering from dementia. Methods: Studies were retrieved from several bibliographic databases (January 2009 to December 2017) with prespecified selection criteria, data extraction, and methodological quality assessment. Results: In total, 10 reality orientation, 25 skills training, and 12 mixed trials were identified as meeting the inclusion criteria and were systematically reviewed. Results from reality orientation trials showed minor effects for cognitive assessments, while skills training trials and mixed trials showed contradicting effects on cognition. Effects on other outcomes (e.g., daily functioning, depression, language) were limited or not found. Conclusions: Skills training trials and mixed trials seem to affect cognitive impairment in a positive way, although the results are inconclusive. Comparison between studies was difficult due to differences in form of intervention. Because findings are inconclusive, more structuralized and comparable randomized controlled trials are needed.