Mateu Serra-Prat

Home palliative care as a cost-saving alternative: evidence from Catalonia

The aim of this study was to provide a comparative assessment of the health care resources consumed during the final month of life of patients undergoing palliative treatment and who died from cancer in the town of Mataró, Spain, in 1998, with respect to whether they benefited from home care teams or not. Relevant differences in the use of health care resources were found between the groups. Patients in the standard care group presented more hospital care admissions and longer length of stay, higher use of emergency and outpatient visits, and greater use of palliative care units within nursing homes than patients in the home care group. The monetary quantification of the use of the above-mentioned resources showed a 71% increase in the cost per patient in the standard care when compared to home care. According to the results of this study, home care teams for terminal cancer patients allow for savings to the health care system. A series of policy making and health services research implications are discussed.

Traducción, adaptación y validación de la Palliative Care Outcome Scale al español

Fundamento y Objetivo El objetivo de este estudio es traducir y validar al espanol la Palliative Care Outcome Scale (POS). Material y Metodo La traduccion y adaptacion se realizo por el metodo de traduccion y retraduccion centrada en garantizar la equivalencia conceptual de los terminos utilizados. Para el estudio de las propiedades psicometricas se selecciono una muestra de 200 enfermos en cuidados paliativos a los que, en una primera visita, se les aplico, ademas del cuestionario a evaluar, el EORTC QLQ C-30, el indice de Barthel y el de Karnofsky. Para la evaluacion de la fiabilidad intraobservador, a la semana de la primera visita se volvio a aplicar la version espanola de la POS. Resultados El proceso de traduccion y adaptacion no planteo mayores problemas. La Escala de Cuidados Paliativos (ECP) mostro una excelente aceptacion tanto por parte de los enfermos como de los profesionales sanitarios, asi como una fiabilidad inter e intraobservador con unos coeficientes de correlacion intraclase entre 0,61 y 0,93 segun el item. El analisis de la consistencia interna mostro un α de Cronbach de 0,62 en el formato para el personal sanitario y de 0,64 en el formato para el enfermo. La mayoria de los items de la ECP se correlacionaron con la escala de funcion emocional y la escala de calidad de vida global del EORTC QLQ C-30. Conclusiones La ECP es un instrumento de medida de la calidad de vida de los pacientes en cuidados paliativos valido y fiable que puede ser util tanto en trabajos de investigacion como en la practica clinica diaria.

Prevalencia del déficit de yodo y factores asociados en escolares de 4 años

Fundamento y objetivo: El deficit de yodo durante los primeros anos de vida puede tener consecuencias graves para el correcto crecimiento y desarrollo del organismo. El objetivo de este estudio es conocer la prevalencia del deficit de yodo en los escolares de la ciudad de Mataro (Barcelona), asi como conocer los factores asociados a este deficit nutricional. Pacientes y metodo: Se diseno un estudio transversal de base poblacional que incluyo a todos los ninos y ninas de 4 anos escolarizados en la ciudad de Mataro. Un equipo de medicos realizo la exploracion fisica basica y recogio la muestra de orina para la determinacion de yoduria y la encuesta sobre habitos alimentarios que se habia entregado previamente a los padres. Resultados: Se obtuvieron 860 muestras de orina de los 987 ninos que participaron en el estudio, observandose una yoduria media (DE) de 214,1 (103,3) µg/l y una mediana de 189,0 µg/l. Un 7,8% de los escolares tenia una yoduria igual o menor de 100 µg/l y un 1,2%, menor o igual a 50 µg/l. Se observaron diferencias segun origen, de modo que los autoctonos presentaron una prevalencia (yoduria inferior o igual a 100 µg/l) del 7,0%, los magrebies del 18,4%, los subsaharianos del 20,0% y los de otros grupos etnicos del 14,3% (p = 0,016). Conclusiones: La poblacion escolar estudiada tiene buenas concentraciones de yodo, con una prevalencia de deficit de este nutriente que puede considerarse relativamente baja. Aun ajustando por el conocimiento de la existencia de la sal yodada, este deficit se asocia con el origen (autoctono o inmigrante) de los ninos.

Long‐term effect of ghrelin on nutritional status and functional capacity in the elderly: a population‐based cohort study

Background  Ghrelin stimulates GH release and hunger at a central level. Ghrelin declines with age, which may be partially responsible for functional impairment and frailty.

Evaluación del impacto de una trayectoria clínica sobre el ictus isquémico

Objective: To assess the impact of the implementation of a clinical pathway for stroke patients. Methods: We performed a controlled intervention study without random allocation that compared two non-concomitant cohorts of stroke patients corresponding to the periods immediately before (control group) and after (intervention group) the implementation of a clinical pathway. The main outcome measures were: a) quality of care indicators; b) improvements in functional capacity (Barthel score) and neurological function (Canadian scale); c) nosocomial complications; d) satisfaction, and e) mean length of hospital stay. Results: One hundred and thirty-nine patients were recruited. Sixty-nine corresponded to the period before implementation of the pathway and 70 corresponded to the period after implementation. There were no significant differences between the two groups on admission. A 36.5% reduction in the time from admission to mobilization was observed. No significant differences were observed between the groups for the other quality of care indicators, or in improvements in functional and neurological capacity. Nosocomial complications occurred in 44.5% of patients in the control group compared with 28.6% in the intervention group (p = .039). No significant differences were observed in the overall satisfaction assessment, but patients in the intervention group showed greater satisfaction in the dimensions of «information» and «trust and professionalism». The mean length of hospital stay was reduced from 11 to 10 days. Conclusions: The implementation of the stroke clinical pathway contributed to reducing the length of hospital stay and the number of inpatient complications, as well as to improving some quality of care indicators.

Screening and clinical management of prostate cancer. A cross-national comparison.

OBJECTIVES The objectives of the study were to identify the current standards of clinical practice regarding prostate cancer screening in western Europe, Canada, and the United States, and to highlight major characteristics of current prostate cancer screening programs or patterns of practice. METHODS We performed a semi-structured interview by means of a self-administered questionnaire sent by fax to 26 institutes pertaining to the International Network of Agencies for Health Technology Assessment. RESULTS None of the countries surveyed had a formal national screening policy. Despite that, all the countries answering the questionnaire had discretionary, public-financed screening practices. Moreover, some scientific and professional organizations recommended population screening for prostate cancer, and few of the surveyed countries offered it as experimental practice within a randomized controlled trial. Survey results showed variation regarding screening policies, in particular test of choice, age cut-off points, and treatment prescribed for positive test results. CONCLUSIONS Despite the lack of conclusive evidence on the benefits of prostate cancer screening, the availability of simple and easy-to-administer tests has lead to an enormous variation on screening policies around the world. Practice variations also affect prostate cancer therapy.

Risk factors for community-acquired pneumonia in adults: Recommendations for its prevention

Community-acquired pneumonia (CAP) remains an important cause of morbidity and mortality in developed countries. The disease is one of the top 10 causes of death and up to the present time, standard aggressive medical care has not resulted in a decrease in mortality. Knowledge of risk factors for CAP is essential to the design of preventive measures to reduce its incidence. Preventive strategies promoting effective vaccines or identifying and acting on modifiable risk factors are of paramount importance in reducing CAP-related death. Most studies have been performed in patients referred for inpatient care or in CAP cases in which a specific pathogen has been identified, but data from population-based studies are scarcer. We present a review of the main risk factors for CAP in adults, classified in the following categories: (a) Comorbidities and their treatments, (b) demographic and socioeconomic factors, (c) lifestyle factors and (d) environmental factors. We conclude with some brief recommendations on preventive measures and vaccination.