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Biomedical subjects

Salvador Peiró

Publications and source records attributed to Salvador Peiró.

18 recordsLinked to original sources
PubMed2006

[The secondary prevention of ischaemic heart disease in Spain. A systematic review of observational studies].

OBJECTIVE: To describe the use of ischaemic heart disease (IHD) secondary prevention measures in the Spanish National Health System. DESIGN: Systematic review of observational studies with information on the use of preventive treatment and measures in the prevention of secondary IHD. SETTING: Primary care and specialised out-patient clinics. DATA SOURCES: Medline search and complementary searches of studies published between 1995 and 2004 with a description of the use secondary prevention measures on hospital discharge or in the follow up after discharge. SELECTION OF STUDIES: A total of 125 references were found after the MEDLINE search, 13 of which were selected after an independent review by 2 researchers. The complementary sources provided 9 more studies giving a total of 22. DATA EXTRACTION: One researcher extracted information on the characteristics of the study and the results variables, which were independently verified by a second evaluator. RESULTS. In the 22 studies found, a high level of variation was shown in the different treatment rates: anti-aggregants (at discharge, 72%-97.1%; follow-up, 46.4%-93.8%); beta-blockers (at discharge, 29%-68.3%; follow-up, 22.4%-59.0%); drugs with action on the renin-angiotensin system (at discharge, 16.2%-52.2%; follow-up, 6.1%-53.1%); lipid lowering drugs (at discharge, 6.7%-88.7%; follow-up, 24.5%-89.5%). The treatment rates showed a progressive improvement over time during the period studied. CONCLUSIONS: In the period 1994-2003 treatment rates in the secondary prevention of IHD have increased, although there is still much room for improvement.

Cardiovascular Agents↗
PubMed2006

[Spanish version of the DASH questionnaire. Cross-cultural adaptation, reliability, validity and responsiveness].

BACKGROUND AND OBJECTIVE: The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is a specific outcome instrument developed to measure upper-extremity disability and symptoms. The aim of this work is to develop a Spanish version of the DASH questionnaire and to analyze its reliability, validity and responsiveness. MATERIAL AND METHOD: We performed cross-cultural adaptation of the DASH to Spanish, using a process that included double forward and backward translations, expert review and field-testing. The Spanish version's reliability, content, construct and criterion validity and responsiveness were then evaluated in 98 patients with upper-extremity conditions that completed the DASH and SF-36 generic health questionnaire before and after medical rehabilitation treatment. RESULTS: We obtained a Spanish DASH version (DASHe) linguistically and conceptually equivalent to the original version. Internal consistency of the DASHe was high (Cronbach alpha = 0.96), test-retest reliability was excellent (r = 0.96) and the floor and ceiling effects were negligible. Construct and criteria validity was shown by a positive association of DASHe scores with worse condition, and a significant correlation with the SF-36 scores, stronger with the SF-36 pain dimension. Responsiveness was excellent (effect size and standardized response means higher than 0.80). CONCLUSIONS: The DASHe is a reliable, valid and responsive instrument that can provide a standardized measure in Spanish patients with upper-extremity musculoskeletal conditions.

Adult↗
PubMed2006

[Secondary prevention of coronary heart disease and gender perspective in two primary healthcare centers].

BACKGROUND AND OBJECTIVE: Our goal was to describe the secondary prevention of coronary heart disease activities in two primary healthcare centers and to analyze differences according to gender. PATIENTS AND METHOD: Retrospective follow-up study (medical records audit) during one year of 187 patients discharged after one myocardial infarction to identify the use of preventive advice and treatments. RESULTS: Men had more exercise (66.7%), smoking (62.9%) and alcohol advice (20.0%) and less diet advice (62.9%) than women (34.3%, 2.9%, 0.0%, 94.3%, respectively). After one year of follow-up, there were no differences in antiplatelet therapy (99.3%), betablockers (41.4%) and statins (70.7%), yet the use of drugs with action on the renin-angiotensin system showed notable differences (men: 50.5%; women: 5.7%; P < .05). Overall, 66.6% of the men vs. 31.4 of the women received three or more treatments. There were no differences among health centers. CONCLUSIONS: Although secondary prevention seems to have improved along time, some problems remain, especially in women.

Aged↗
PubMed2006

[What incentives foster hospital use in the National Health Service?].

BACKGROUND: Geographic variations in medical practice have been widely described and different underlying causes have been proposed. Basically, when evidence about effectiveness is strong variations are lower and, probably, it reflects patient needs differences; nevertheless, when either uncertainty or ignorance about effectiveness dominates, medical decision making is particularly sensitive to supply. In this paper we argue about the factors (incentives) influencing hospital utilization in the Spanish National Health Service (sNHS). MATERIAL AND METHOD: We have compared both sNHS utilization rates and those in MEDICARE (US Federal Health System for elderly and handicapped population). RESULTS: 1) Utilization rates in Spain were lower than in MEDICARE for most of the conditions and procedures under study. However, knee or hip replacement and cholecystectomy rates were similar; 2)unlike what happened in MEDICARE, supply, as total beds per 1,000 inhabitants, showed either negative or no correlation with utilization rates; however, those populations which get more interventions get more of whatever the surgery performed; 3)High tech hospitals, in terms of tertiary and teaching hospitals, perform less < > interventions; on the other hand, < > utilization rates were closed to those in MEDICARE. CONCLUSIONS: Differences between both Health Care Systems suggest a different structure of incentives working under variations. Here in Spain, instead of supply, < > is becoming the alternative explanation. If true, < > hypothesis entails a model of National Health Service focused on technology instead of patient needs.

Aged↗
PubMed2005

[Inappropriate hospitalization use in general surgery wards. Magnitude, associated factors and causes].

OBJECTIVE: To determine the proportion of inappropriate days of hospitalization in the general surgery wards of three university hospitals, its causes, and associated factors. MATERIAL AND METHOD: We concurrently reviewed 596 days of hospitalisation during a 1-week period in 2000, using the Appropriateness Evaluation Protocol (AEP). The association among inappropriate days of hospital stay and independent variables was evaluated using bivariable and multivariable methods. Finally, the causes for inappropriate hospitalization use were analyzed. RESULTS: The percentage of inappropriate days was 17.6%, with no significant differences among the hospitals (21.5%, 12.5% and 17.5%). Inappropriate days were associated with the weekend (odds ratio [OR] = 2.1, scheduled admissions (OR = 2.9), hospital stay of more than 1 week (OR:2.3), the last third of the hospital stay (OR: 3.7), and inappropriate admission (OR: 2.1). The main causes of inappropriate hospital stays were organizational problems in the hospital or in the clinical management of discharge. CONCLUSIONS: Inappropriate days of hospitalization represent a considerable percentage of hospitalization in surgery wards. The main reasons for inappropriate days are problems with surgical and discharge planning and factors that depend on the organization of the surgery departments and other related departments in the hospital.

Adult↗
PubMed2005

[Adverse outcomes in the surgical treatment of acute appendicitis].

OBJECTIVES: To describe adverse outcomes after appendectomy for acute appendicitis and to analyze the association between these outcomes and specific characteristics of the patient and hospital admission. MATERIAL AND METHODS: We studied a cohort of 792 patients who underwent appendectomy for acute appendicitis. Postoperative complications, reoperations and deaths were prospectively studied and all readmissions were retrospectively identified. Logistic regression was used to evaluate the relationship between complications and patient characteristics, as well as hospital admission. RESULTS: Postsurgical complications developed in 9.8% of the patients. These complications mainly consisted of surgical wound infection (4.2%) and intra-abdominal complications (2.1%). A total of 0.7% of patients underwent reoperation during admission, 0.5% were admitted to the intensive care unit and five patients (0.6%) died in hospital. The rate of operation-related readmissions in the following year was 3.2%. Length of hospital stay was longer in patients with complications than in those without complications (9.6 and 3.5 days, respectively). Postoperative complications were associated with older age (45-65 years, OR 3.62, p < 0.001; more than 65 years OR 8.68, p < 0.001) and acute appendicitis complicated with peritonitis or perforation (OR 3.69, p < 0.005). Readmissions related to previous surgery were associated only with complications during the first admission (OR 18.79, p < 0.001). CONCLUSIONS: In appendectomy, the most frequent adverse outcomes are surgical wound infection and intra-abdominal complications, which are associated with older patients and perforations. This subgroup of patients at high risk requires closer surveillance.

Adolescent↗
PubMed2004

Length of stay and antipsychotic treatment costs of patients with acute psychosis admitted to hospital in Spain. Description and associated factors. The Psychosp study.

OBJECTIVE: The aim of this study was to describe the length of stay, cost of drug treatment, diagnostic tests and other therapeutic measures in acute psychotic patients admitted to acute in-patient psychiatric units and to analyse the factors associated with these. METHODS: A retrospective review was made of medical records of 200 patients admitted for acute psychosis in eight Spanish hospitals. Information was collected concerning the length of stay, cost of drug treatment and diagnostic tests; bivariate and multivariate analysis was made of factors associated with length of stay and cost of antipsychotic drug treatment. RESULTS: The average admission cost ranged between 2,830.29 and 3,624.95 euros, with a wide variability among hospitals. Of this cost, 94.3% corresponded to fixed costs, 3.4% to diagnostic tests and 2.4% to drug treatment (84.2% of this latter cost corresponded to antipsychotic drugs). Age younger than 25 years and a diagnosis of schizophrenia were associated with longer hospital stays; longer length of stay, the presence of aggressiveness/agitation, a diagnosis of schizophrenia, age younger than 25 years and the use of atypical antipsychotics were associated with higher costs in antipsychotic drug treatment. CONCLUSIONS: The hospital admission cost of an acute psychotic episode is mostly dependent on the structural costs derived from in-patient treatment. The differences in costs seem to be related to the different length of stay schemes used by the various hospitals rather than to the clinical characteristics of patients or the drugs used.

Acute Disease↗
PubMed2004

A risk score system for identification of patients with upper-GI bleeding suitable for outpatient management.

BACKGROUND: The aim of this study was to develop a risk score system for identification of patients with upper-GI hemorrhage who are suitable for outpatient management. METHODS: From a prospective cohort of 983 consecutive patients with upper-GI hemorrhage not associated with portal hypertension, 581 cases that did not meet pre-established criteria for admission were selected, and a logistic regression analysis was performed to identify factors associated with two adverse outcomes: recurrent bleeding and/or the need for emergency surgery. The risk score system was developed by using the beta coefficients of the logistic model, and its performance was evaluated. The results of this model were combined with pre-established criteria for admission to build a simplified scoring system for identification of patients who can be managed safely on an outpatient basis. RESULTS: Chronic alcoholism, active malignancy, prior upper digestive tract surgery, wasting syndrome, hemodynamic compromise, duodenal ulcer as the cause of upper-GI hemorrhage, and hemorrhage of unknown cause were independently associated with a greater risk of unfavorable outcomes in the group that did not meet pre-established criteria for admission. The logistic model showed a high capacity for discrimination (C statistic: 0.87) and good calibration (p value for Hosmer-Lemeshow goodness-of-fit test, 0.62), with a sensitivity of 100% and specificity of 64%. The simplified score had a sensitivity of 100% and specificity of 29% for adverse outcomes, and sensitivity of 78% and specificity of 38% for mortality. CONCLUSIONS: The score system developed in this study may be helpful in deciding between hospitalization and outpatient management for patients with upper-GI hemorrhage, but it remains to be validated in patient groups other than those used for its development.

Acute Disease↗
PubMed2004

Exploring the impact of complications on length of stay in major surgery diagnosis-related groups.

STUDY OBJECTIVE: To analyze, in terms of the length of stay (LOS), the use of resources by patients classified under surgical diagnosis-related groups (DRGs) with complication and/or comorbidity (DRGCCs), divided into subgroups where complications were and were not detected, and to explore the repercussions on hospital reimbursement. DESIGN: The Complication Screening Program(Copyright ) (CSP) was used to divide the patients in 14 DRGCCs into subgroups with and without complications, and to compare the LOS between the subgroups and with the equivalent DRG without CC. The ratios between the LOS and the relative weight of the DRGs for reimbursement were also compared. SETTING: The population hospitalized for major surgery between 1995 and 1999 in the Hospital of Mataró, Catalonia, Spain. PARTICIPANTS: Patients (4227) hospitalized for major surgery. MAIN RESULT: The percentage of complications identified by the CSP ranged from 17.5% to 52.4%. The LOS of the DRGCCs was almost twice as long as in the DRGs without CC; 2.48 times greater if the DRGCC was flagged by the CSP and 70% greater if it was not. On average, the DRGCCs selected were reimbursed at a rate 93% higher than their counterpart DRGs without CC. In 11 of the 14 DRG pairs with or without CC, the reimbursement ratio was lower than the LOS ratio. CONCLUSIONS: DRGCCs can be classified into clearly differentiated groups based on the presence or absence of CSP-flagged complications. CSP-flagged complications produce an increase in LOS greater than the increase in the relative weights for reimbursement.

Comorbidity↗
PubMed2003

Accuracy of pharmaceutical advertisements in medical journals.

BACKGROUND: Because of the effect of the ever-growing evidence-based medicine movement on prescribing behaviour of doctors, the pharmaceutical industry incorporates bibliographical references to clinical trials that endorse their products in their advertisements. We aimed to assess whether the references about efficacy, safety, convenience, or cost of antihypertensive and lipid-lowering drugs included in advertisements supported the promotional claims. METHODS: We assessed all advertisements for antihypertensive and lipid-lowering drugs published in six Spanish medical journals in 1997 that had at least one bibliographical reference. Two pairs of investigators independently reviewed the advertisements to see whether the studies quoted to endorse the advertising messages supported the corresponding claims. FINDINGS: We identified 264 different advertisements for antihypertensive drugs and 23 different advertisements for lipid-lowering drugs. We recorded at least one reference in 31 advertisements in the antihypertensive group and at least one reference in every seven advertisements in the lipid-lowering group, providing a total of 125 promotional claims with references. We could not retrieve 23 (18%) references from monographic works and non-published data on file. 79 (63%) of the 125 references were from journals with a high impact factor; 84 (82%) of the 102 references retrieved were from randomised clinical trials. In 45 claims (44.1%; 95% CI 34.3-54.3) the promotional statement was not supported by the reference, most frequently because the slogan recommended the drug in a patient group other than that assessed in the study. INTERPRETATION: Doctors should be cautious in assessment of advertisements that claim a drug has greater efficacy, safety, or convenience, even though these claims are accompanied by bibliographical references to randomised clinical trials published in reputable medical journals and seem to be evidence-based.

Advertising↗
PubMed2002

Effectiveness of feedback to physicians in reducing inappropriate use of hospitalization: a study in a Spanish hospital.

OBJECTIVES: To evaluate the effectiveness of feedback to medical staff in reducing inappropriate hospital days, particularly those attributable to conservative medical discharge policies. DESIGN: Quasi-experimental pre-test/post-test with non-equivalent control group. SETTING: A publicly funded hospital in industrial belt in Barcelona (Spain), serving a predominantly urban population of 100,000. STUDY PARTICIPANTS: Two non-equivalent groups: control group (surgery department) and intervention group (internal medicine department). INTERVENTION: Meetings between hospital management and medical staff of the intervention group to inform clinicians of percentages and reasons for inappropriate stays in their departments. MAIN OUTCOME MEASURES: Total inappropriate hospital days and percentage attributable to physicians, measured with the Appropriateness Evaluation Protocol before, during, and after intervention. RESULTS: There were no relevant differences in the characteristics of the populations whose stays were reviewed during each of the periods. The total number of inappropriate stays and the percentage attributable to the doctor in the control group did not show any differences between the periods. In the intervention group, inappropriate stays attributable to the doctor decreased from 35.9% in the period to intervention to 27.7% during intervention (relative drop of 22.8%; P < 0.01), and rose to 32.7% after intervention. Differences in total inappropriate days were not significant. CONCLUSIONS: Providing physicians with feedback about percentage of inappropriate hospital days produced a significant reduction in the number of inappropriate stays attributable to the doctor, although the impact on overall inappropriate stays is inconclusive.

Aged↗
PubMedDate not supplied

[The quality of care in shoulder pain. A medical audit].

BACKGROUND: To evaluate the quality of hospital ambulatory care in non-surgical painful shoulder by auditing medical records using quality indicators. MATERIAL AND METHODS: We reviewed 245 medical records of non-surgical patients assisted for pain shoulder in 1999-2000 in two public hospitals. Quality of care indicators for antecedents, physic exploration, diagnosis and treatment were developed based in systematic reviews of clinical trials, guidelines and expert criteria. Medical records review was carried out by two rehabilitative doctors. Fulfilling of quality criteria and differences between hospitals was analyzed. RESULTS: 76.3% of the medical records did not fulfill > or = 4 of 10 quality criteria for antecedents, 61.6% did not fulfill > or = 3 of 10 criteria for physical exploration, and 7.7% did not have any diagnosis registered. 96.9% of the 98 patients with impingement syndrome did not complete the criteria of anti-inflammatory treatment or infiltration in the pre-established time, and up to 15.3% had not been proposed physiotherapy or programmed exercise in the 4 weeks after the diagnosis; 95.8% of the 24 patients with rotators cuff tears were not proposed for early surgical evaluation, and 86.7% of the 15 cases of adhesive capsulitis did not receive instructions to carry out programmed exercise in the proposed times. CONCLUSIONS: The audit revealed significant deficiencies in adherence to quality indicators in non-surgical pain shoulder. Part of these problems can be due to low medical records quality.

Humans↗
PubMedDate not supplied

[Setting health services research priorities in the public health system. An approach through expert consensus].

OBJECTIVES: The aim of the present paper was to identify and prioritise health services research issues, from the perspective of Spanish NHS enrollees' health needs. METHODS: 13 experts attended to a structured consensual meeting by using a two-phase process, sharing both Nominal Group and Delphi Technique features. Health Services Research Priorities were identified and scored (7 to 9, high relevance; 4 to 6 mild relevance and 1 to 3, low or no relevance). Results were sorted regarding the median score and its dispersion. RESULTS: 53 research issues were identified. Strategies to improve effectiveness in health care, information to patients, health care quality and safety, equity, access and sustainability were considered of high priority and high consensus; just 4 items had remarkable dispersion (Intercuartile interval [ICI] > or = 2). Organizational improvement, productivity and efficiency enhancement, workforce and equipments were classified of mild priority. Additionally, this group of items reached very low consensus: 59% of them reached ICI > or = 2. CONCLUSIONS: Our approach offers reference about priorities to Spanish health services researchers, and also, orientation to financers and users of this kind of research, though several limitations have been described.

Consensus↗
PubMedDate not supplied

[An approach to "quality-adjusted life years" quality of life weights from self-assessed health status].

OBJECTIVES: To estimate quality of life weights in Spain for 1987, 1993 and 2001, based on self-assessed health status reported in the National Health Survey. MATERIAL AND METHODS: Quality of life weights were estimated using an ordered probit model. In this model, self-assessed health status was related to the presence of chronic diseases, demographic characteristics, and a random error. Quality of life weights were derived by normalizing the regressors obtained. RESULTS: Quality of life values related to chronic diseases varied depending on the diseases. Pain, limitations, and diseases in the previous 12 months had a greater negative impact on quality of life than did chronic diseases. Quality of life decreased as age increased, and increased as educational level increased. For the same disease and adjusted for age, sex, and educational level, quality of life weights were greater for 1993 and 2001 than for 1987. CONCLUSIONS: The proposed methodology allows quality of life weights to be calculated from health survey data, which has direct application in economic assessment, analysis of socioeconomic health inequalities, and health capital estimation.

Adult↗