Jordi Delás

Evaluación de una intervención domiciliaria en pacientes con insuficiencia cardíaca. Resultados de un estudio aleatorizado

Introduccion y objetivos Conocida la eficacia de los programas domiciliarios para pacientes con insuficiencia cardiaca (IC), nos hemos propuesto evaluar las diferencias en los ingresos hospitalarios, las visitas al servicio de urgencias, los costes economicos y la calidad de vida tras una intervencion educativa en el domicilio una semana despues del alta, realizada por personal de enfermeria. Pacientes y metodo Los pacientes ingresados por IC sistolica en los servicios de cardiologia y medicina interna fueron distribuidos, mediante tabla de numeros aleatorios, en un grupo que recibio intervencion educativa y otro grupo control que fue atendido de forma convencional. Resultados Desde julio de 2001 hasta noviembre de 2002 se distribuyo a 70 pacientes en los 2 grupos. A los 6 meses de seguimiento, el grupo de 34 pacientes que recibio la intervencion educativa, comparado con el grupo de 36 pacientes que no la recibio, tuvo en promedio menos visitas a urgencias (0,21 frente a 1,33; p Conclusiones Los pacientes con IC sistolica que han recibido una intervencion educativa domiciliaria tienen una significativa menor tasa de reingresos, mortalidad y coste, con una mejor calidad de vida. Algunas limitaciones del estudio hacen recomendable la replicacion de las observaciones.

Evaluation of a Home-Based Intervention in Heart Failure Patients. Results of a Randomized Study

INTRODUCTION AND OBJECTIVES Home-based interventions after hospital discharge in patients with heart failure (HF) have been shown to decrease readmission and mortality rates. The primary aim of this study was to determine the effect of a home-based educational intervention carried out by nursing staff on the readmission rate, emergency department visits, and healthcare costs. PATIENTS AND METHOD Patients hospitalized with systolic HF were randomly assigned to receive either usual care or a single home-based educational intervention 1 week after discharge. RESULTS Between July 2001 and November 2002, 70 patients entered the study: 34 in the intervention group and 36 in the control group. During the 6-month follow-up, there were fewer unplanned readmissions in the intervention group than in the control group (0.09 vs 0.94; P<.001), fewer emergency department visits (0.21 vs 1.33; P<.001), and fewer out-of-hospital deaths (2 vs 11; P<.01). Costs were also significantly lower in the intervention group (difference, ; 1190.9; P<.001). Moreover, patient-perceived health status, as indicated by scores on a quality-of-life questionnaire, increased significantly in the intervention group. CONCLUSIONS In a cohort of patients with systolic HF who received a home-based educational intervention there were significant reductions in the unplanned readmission rate, mortality, and healthcare costs, and better quality of life. Some limitations of the study warrant validation of the resultats in further studies.

Long-term implications of a single home-based educational intervention in patients with heart failure

OBJECTIVE The objective of the study was to evaluate the effectiveness of a single home-based educational intervention for patients admitted with heart failure. METHODS There were 106 patients: 42 in the intervention group and 64 in the control group. Patients were randomly assigned to receive an intervention by nursing staff 1 week after discharge. Primary end points were readmissions, emergency department visits, deaths, costs, and quality of life. RESULTS During the 24-month follow-up, there were fewer mean emergency department visits in the intervention group than in the control group (.68 vs 2.00; P = .000), fewer unplanned readmissions (.68 vs 1.71; P = .000), and lower costs (€ 671.56 =

Utilidad del Minnesota Living With Heart Failure Questionnaire en la evaluación de la calidad de vida en enfermos con insuficiencia cardiaca

974.63 = GBP598.42 per person vs € 2,154.24 =

Smoked cocaine in socially-depressed areas

3,126.01 = GBP1,919.64; P = .001). There was a trend toward fewer out-of-hospital deaths (14 [46.6%] vs 31 [55.3%]; P = .45) and improvement in quality of life. CONCLUSION Patients with heart failure who receive a home-based educational intervention experience fewer emergency department visits and unplanned readmissions with lower healthcare costs.

Ciudadanos del este de Europa consumidores de drogas en Barcelona

The Minnesota Living With Heart Failure Questionnaire (MLWHFQ) was used to evaluate the quality of life of patients with heart failure, both before and 6 months after an educational intervention. The study included 99 patients (70 male) with a mean age of 78 years. Significant correlations were found between the MLWHFQ score and the SF-36 score (r=0.41, P=.01), the Barthel Index score (r=‐0.23, P=.02), New York Heart Association functional class (r=0.37, P=.01), and the number of readmissions within 6 months (r=0.47, P<.002). Following the intervention, the MLWHFQ score decreased by 34 points (P=.0001). The MLWHFQ score appears to be a useful measure: there were good correlations with functional class and the SF-36 score, and the measure was sensitive to changes in health since there was also a correlation with the patients’ prognosis.

Ver, oír y aprender: una filmación educativa para la enseñanza de habilidades en exploración física

BackgroundThe main objectives of this study are to describe the smoked cocaine users profile in socially-depressed areas and their needs from a harm-reduction perspective, to investigate their use of smoking crack and compare the acute effects between injecting and smoking consumption.MethodsThe study took place in SAPS, Barcelona, Spain. Two focus group sessions were undertaken with a total of 8 drug users. Secondly, the 8 participants answered a structured questionnaire and in the course of the sessions, as a snowball activity, were trained to survey 6 other crack smokers.ResultsWe obtained 56 questionnaires. The majority of participants were from non-European Community countries (62.69%), 70.2% of participants referred to sharing the smoking equipment. The most frequent symptoms reported during smoked cocaine were mydriasis (83.33%)), perspiration (72.92%) and compulsive object search (70.83%) During the group sessions, participants said that smoked cocaine is much more addictive than injected cocaine and causes more anxiety. Participants also reported the difficulty of changing from injected use to smoked use, due to the larger amount of cocaine needed to reach the same effects as when having injected.ConclusionsWe can conclude that the research, focused on achieving greater knowledge of the smoked cocaine users profile, their usage of smoking crack, consumption patterns and acute effects, should be incorporated into substance misuse interventions.

Utility of the Minnesota Living With Heart Failure Questionnaire for assessing quality of life in heart failure patients

Desde mayo de 1999 hasta mayo de 2001, hemos contactado en el SAPS (Servicio de Atencion Social y Sanitaria) de Barcelona con usuarios de drogas de paises del este de Europa. Acuden a centros terapeuticos gratuitos, aunque pagan por la organizacion del viaje unos 500 euros. Son jovenes entre 18 y 30 anos y mantienen el contacto con sus familiares. Conocen los riesgos de transmision de enfermedades, pero suelen reutilizar las jeringas. Es alta la prevalencia de hepatitis C (92%) y B (62%) y menor la de infeccion por el VIH (19%). Si no abandonan las drogas, el retorno es un fracaso y tienen dificultades para proseguir los tratamientos con metadona o antirretrovirales. La respuesta asistencial ha de adecuarse a sus necesidades. Se debe procurar la mediacion cultural y la informacion en los lugares de origen, supervisar los centros terapeuticos y disenar alternativas a los abandonos. Hay que desarrollar la colaboracion internacional, estimular programas de disminucion de riesgos derivados del consumo y evitar que del tratamiento se haga un comercio.

Enfermedad por émbolos de colesterol.

Introduccion. hemos desarrollado un cortometraje educativo para la formacion en exploracion fisica de estudiantes de medicina de tercer ano, sin experiencia previa en habilidades clinicas. Materiales y metodos. El estudiuo se ha realizado en el Servicio de Medicina Interna del Hospital Universitari Sagrat Cor de Barcelona durante dos anos consecutivos. Se efectuaron evaluaciones sobre exploracion fisica de los estudiantes antes y despues de ver la pelicula. La primera evaluacion se llevo a cabo el primer dia de estancia de los estudiantes en el hospital. A continuacion, visualizaron la filmacion y se les informo de que al cabo de 48 horas se efectuaria una segunda evaluacion en la que deberian realizar una exploracion fisica de acuerdo con lo que habian visto y oido en el cortometraje. Al final del periodo de seis semanas de estancia en el hospital se realizo una tercera evaluacion. Todas las evaluaciones se llevaron a cabo por el mismo profesor, a partir de un listado de contenidos evaluativos elbaorado previamente. Resultados. Despues de ver la pelicula, 48 horas despues de su llegada al hospital, los estudiantes habian mejorado en las diferentes pruebas de exploracion fisica, en una tasa mesia del 43,4%. Al cabo de seis semanas, se aprecion un 14,3% de mejora en relacion con la segunda evaluacion del tercer dia del curso. Conclusion. Un cortometraje es un buen medio para la formacion en la exploracion fisica normal, mas rapido que otros sistemas de ensenanza y favorece la adopcion de competencias estables.