Adherence to treatment in patients with psoriasis is often poor. An investigation of patient preferences and satisfaction with treatment may be important, based on the expected correlation with ...therapy compliance. This paper aims to examine and describe the current literature on patient preferences, satisfaction and adherence to treatment for psoriasis in the European Union (EU).
Electronic searches were conducted using PubMed, ISI Web of Knowledge, Scopus, Spanish databases and Google Scholar. European studies published in English or Spanish between January 1, 2009 and December 31, 2014 regarding patient-reported outcomes in psoriatic patients were included. Studies conducted in non-EU countries, letters to the editor, editorials, experts' opinions, case studies, congress proceedings, publications that did not differentiate between patients with psoriasis and psoriatic arthritis or studies related to specific treatment were excluded.
A total of 1,769 titles were identified, of which 1,636 were excluded as they were duplicates or did not provide any relevant information. After a full-text reading and application of the inclusion/exclusion criteria, 46 publications were included. This paper will describe publications on adherence (n=4), preferences (n=5) and satisfaction with treatment (n=7). Results related to health-related quality of life articles (n=30) have been published elsewhere. Adherence rates are generally low in psoriasis patients regardless of the type of treatment, severity of disease or methods used to measure adherence. Biologic therapy is associated with greater clinical improvement. There is a direct association between physician recommendations, patient preferences and several domains of treatment satisfaction.
The results of this review support the conclusion that adherence rates in patients with psoriasis are suboptimal and highlight the need to improve patient compliance and satisfaction with treatment. Patients' preferences should be taken into account in the treatment decision-making process in order to improve patients' clinical outcomes by ensuring satisfaction and adherence.
Malnutrition is a common condition associated with various pathologies such as infections, neoplasms and digestive system disorders. Patients can be managed using different strategies, which include ...dietary modifications or oral nutritional supplements (ONS). It is important to promote good ONS adherence in order to attain clinical efficacy and cost-effectiveness. Several factors (amount, type, duration and tolerability) may have an impact on ONS adherence. PerceptiONS is a descriptive, cross-sectional observational study based on an ad hoc electronic survey designed to explore physicians' perception of malnourished outpatients prescribed ONS. The survey considered adherence, acceptance/satisfaction, tolerability and benefits within the context of Spain's healthcare system. The perceptions of 548 physicians regarding the experience of 2516 patients were analyzed. From the physicians' perspective, 57.11% of patients adhered to over 75% of the prescribed ONS. The organoleptic properties of ONS represented the aspect with the most positive impact on adherence, with smell (43.72%) ranking as the top characteristic. In general, patients were satisfied (90.10%) with the ONS, with their related benefits (88.51%) and their organoleptic properties (90.42%), and accepted ONS in their daily diet (88.63%). ONS improved patients' general condition (87.04%), quality of life (QoL) (81.96%) and vitality/energy (81.28%). Physicians would prescribe the same ONS again in 96.4% of the cases.
Summary
To reach a Spanish expert consensus on a treat-to-target strategy in osteoporosis, a Delphi Consensus Study has been developed. Most of the experts (59.8%) were rheumatologist with a mean ...clinical experience of 21.3 years (SD 8.5). Consensus was achieved for 70% of the items. Therapeutic objectives, patient follow-up scheme, treatment failure criteria, and appropriate treatment choice for use in T2T strategy in Spain have been defined.
Introduction
The paper aims to achieve a Spanish expert consensus on a treat-to-target (T2T) strategy in osteoporosis.
Methods
A scientific committee led the project and was involved in expert panel identification and Delphi questionnaire development. Two Delphi rounds were completed. The first-round questionnaire included 24 items and assessed, using a seven-point Likert scale, the experts’ wish (W) and prognosis (P) in 5 years for each topic (applicability, therapeutic objectives, patient follow-up, and possible treatment to be prescribed). Items for which there was no consensus in the first round were included in the second round. Consensus was defined as ≥75% agreement (somewhat/mostly/entirely agree) or disagreement (somewhat/mostly/entirely disagree) responses.
Results
Of the experts, 112 and 106 completed the first and second rounds, respectively. 59.8% were rheumatologists with a mean clinical experience of 21.3 years (SD 8.5). Consensus was achieved for 70% of the items, and was established regarding the utility of a T2T strategy to define therapeutic objectives, optimal follow-up, and therapeutic algorithm. Participants agreed on the utility of the bone mineral density (BMD) value (T-score >−2.5 SD for spine and >−2.5/−2.0 SD for femoral neck), lack of fractures, and fracture risk (FRAX) as therapeutic objectives. For measuring BMD changes, consensus was achieved on the suitability of hip and femoral neck locations. Experts agreed to consider treatment failure as when a significant BMD gain could not be achieved, or when a new fracture occurs within 2–3 years. There was consensus that all proposed therapies should achieve a therapeutic target through T2T strategy (treatments with the highest consensus scores were denosumab and teriparatide).
Conclusion
The therapeutic objectives, patient follow-up scheme, treatment failure criteria, and appropriate treatment choice for use in T2T strategy in Spain have been established by a panel of experts. Some aspects nevertheless still require further analysis.
The aim of this work is to describe the characteristics of stroke units and stroke teams in Spain.
We performed a cross-sectional study based on an ad hoc questionnaire designed by 5 experts and ...addressed to neurologists leading stroke units/teams that had been operational for ≥ 1 year.
The survey was completed by 43 stroke units (61% of units in Spain) and 14 stroke teams. The mean (SD) number of neurologists assigned to each unit/team is 4±3. 98% of stroke units (and 38% of stroke teams) have a neurologist on-call available 24hours, 365 days. 98% of stroke units (79% of stroke teams) have specialised nurse, 95% of units (71% of stroke teams) auxiliary personnel, 86% of units (71% of stroke teams) social worker, 81% of stroke units (71% of stroke teams) have a rehabilitation physician and 81% of stroke units (86% of stroke teams) a physiotherapist. Most stroke units (80%) have 4-6 beds with continuous non-invasive monitoring. The mean number of unmonitored beds is 14 (8) for stroke units and 12 (7) for stroke teams. The mean duration of non-invasive monitoring is 3 (1) days. All stroke units and 86% of stroke teams have intravenous thrombolysis available, and 81% of stroke units and 21% of stroke teams are able to perform mechanical thrombectomy, whereas the remaining centres have referral pathways in place. Telestroke systems are available at 44% of stroke units, providing support to a mean of 4 (3) centres. Activity is recorded in clinical registries by 77% of stroke units and 50% of stroke teams, but less than 75% of data is completed in 25% of cases.
Most stroke units/teams comply with the current recommendations. The systematic use of clinical registries should be improved to further improve patient care.
Rationnel : le NutriQoL® est un questionnaire de qualité de vie (QdV) recommandé par ESPEN pour évaluer la QdV des patients sous nutrition entérale à domicile (NED). Le NutriQoL®, développé et validé ...en Espagne et comprend 17 items qui évaluent la Qdv selon deux dimensions : (1) les performances physiques et les activités de la vie quotidienne, et (2) les aspects sociaux. Ce travail décrit la méthode utilisée pour réaliser l’adaptation linguistique et culturelle du questionnaire NutriQol® aux patients français.
Conformément aux recommandations de l’International Society for Pharmacoeconomics and Outcomes Research (ISPOR), la traduction et l’adaptation culturelle du NutriQoL®, développé et validé en espagnol, ont comporté les étapes suivantes : (1) première traduction par deux personnes indépendantes ; (2) réconciliation des premières traductions ; (3) contre-traduction ; (4) validation de la contre-traduction ; (5) revue par deux experts ; (6) évaluation cognitive sur des patients en NED ; (7) relecture finale. Deux experts en nutrition clinique français ont conduit cette révision.
Cinq patients français en NED ont participé à l’évaluation cognitive. La majorité des patients étaient des femmes (80 %), avec un âge moyen de 67,7 ans 77–58 et une durée moyenne de prise en charge de 8,2 mois 4–15. Les patients présentaient une pathologie digestive pour 60 % d’entre eux (maladie de Crohn 40 %, rectocolite ulcéro-hémorragique 20 %) et dans 40 % des cas un cancer colorectal ou gastrique. Les patients étaient diagnostiqués en moyenne depuis 11 ans 4–21. Au cours de cette évaluation cognitive, il a été demandé aux patients de donner leur avis sur la traduction du NutriQoL® afin de déterminer si la formulation entraînait des difficultés pour répondre, ou pour la compréhension de l’un des items ou si ils auraient formulé l’item différemment. Deux items (16.a et 16.b) ont été modifiés à la suite de cette évaluation.
Cette adaptation linguistique et culturelle rigoureuse permettra l’utilisation du NutriQoL® pour évaluer la qualité de vie des patients francophones bénéficiant d’une NED.
The aim of this work is to describe the characteristics of stroke units and stroke teams in Spain.
We performed a cross-sectional study based on an ad-hoc questionnaire designed by 5 experts and ...addressed to neurologists leading stroke units/teams that had been operational for ≥ 1 year.
The survey was completed by 43 stroke units (61% of units in Spain) and 14 stroke teams. A mean (standard deviation) of 4 (3) neurologists were assigned to each stroke unit/team; 98% of stroke units (and 38% of stroke teams) have an on-call neurologist available 24 hours a day, 98% of units (79% of stroke teams) included specialised nurses, 86% of units (71% of stroke teams) included a social worker, and 81% of units (71% of stroke teams) included a rehabilitation physician. Most stroke units (80%) had 4--6 beds with continuous non-invasive monitoring. The mean number of unmonitored beds was 14 (8) for stroke units and 12 (7) for stroke teams. The mean duration of non-invasive monitoring was 3 (1) days. All stroke units and 86% of stroke teams had intravenous thrombolysis available, and 81% of stroke units and 21% of stroke teams were able to perform mechanical thrombectomy, whereas the remaining centres had referral pathways in place. Telestroke systems were in place at 44% of stroke units, providing support to a mean of 4 (3) centres. Activity is recorded in clinical registries by 77% of stroke units and 50% of stroke teams, but less than 75% of data is completed in 25% of cases.
Most stroke units/teams comply with the current recommendations. The systematic use of clinical registries should be improved to further improve patient care.
El objetivo del trabajo es describir las características de las unidades (UI) y equipos (EI) de ictus en España.
Estudio transversal basado en un cuestionario ad-hoc, diseñado por 5 expertos y dirigido a los neurólogos responsables de las UI/EI con al menos un año de funcionamiento.
Participaron 43 UI (61% del total) y 14 EI. La media (±DE) de neurólogos adscritos a las UI/EI es de 4 ± 3. 98% de las UI frente a 38% de EI cuentan con neurólogo de guardia 24 h/7d. Disponen de enfermería especializada 98% de las UI frente a 79% de los EI, de médico rehabilitador 81% frente a 71% y de trabajador social 86% frente a 71%. La mayoría de UI (80%) tienen 4-6 camas con monitorización continua no invasiva. El número medio de camas no monitorizadas de las UI es de 14 ± 8 y de 12 ± 7 en los EI. La estancia media de los pacientes en las camas monitorizadas de las UI es de 3 ± 1 días. Todas las UI y el 86% de EI pueden realizar trombólisis intravenosa; el 81% de UI y 21% de EI trombectomía mecánica; el resto de los centros tiene posibilidad de derivación. El 44% de UI dispone del sistema teleictus, dando soporte a 4 ± 3 centros. La actividad se recoge sistemáticamente en el 77% de UI y 50% de EI, pero su cumplimentación es < 75% en un 25% de los casos.
La mayoría de las UI y de los EI cumple las recomendaciones actuales. Para seguir mejorando la atención del paciente, resulta necesario optimizar el registro sistemático de su actividad.
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Atopic dermatitis (AD) is a chronic, inflammatory skin disease affecting all age groups, particularly children. This systematic review provides an overview of the humanistic and ...economic disease burden in the pediatric population with AD in Spain. The evidence, collected from 11 observational studies published over the past 10 years, exhibits the most common characteristics of the patients, disease burden, patient-reported outcomes, use of resources, and treatment patterns. The burden of AD extends beyond physical symptoms, with associated comorbidities such as asthma and impaired health-related quality of life and mental health disorders, particularly in severe cases. Traditional therapies, primarily topical corticosteroids, face adherence and efficacy challenges. Despite promising innovative treatments and available biological therapies, their use is still limited in the pediatric population. The findings of the present review highlight the scarce scientific evidence on the economic burden of pediatric AD, as well as the most updated humanistic evidence on this disease. At the same time, the need for individualized care and innovative therapeutic interventions to address the multifaceted challenges of pediatric AD in Spain is evident.
La dermatitis atópica (DA) es un trastorno cutáneo crónico e inflamatorio que afecta a todos los grupos de edad, pero especialmente a los niños. Esta revisión sistemática proporciona una visión general de la carga de la enfermedad en la población pediátrica con DA en España. La evidencia recopilada de 11 estudios observacionales publicados en los últimos 10 años presenta las características más comunes de los pacientes, la carga de la enfermedad, los resultados reportados por los pacientes, el uso de recursos y los patrones de tratamiento más frecuentes. La carga de la DA se extiende más allá de los síntomas físicos, con comorbilidades asociadas como el asma, el deterioro de la calidad de vida relacionada con la salud y trastornos de salud mental, particularmente en los casos graves. Los tratamientos tradicionales, principalmente los corticosteroides tópicos, enfrentan desafíos de adherencia y eficacia. A pesar de las prometedoras innovaciones terapéuticas y la disponibilidad de terapias biológicas, su uso permanece limitado en población pediátrica. Los resultados de la presente revisión resaltan la escasa evidencia científica sobre la carga económica de la DA pediátrica, así como la evidencia humanística más actualizada de la enfermedad. Asimismo, se hace patente la necesidad de una atención personalizada e intervenciones terapéuticas innovadoras para abordar los desafíos multifacéticos de la DA pediátrica en España.
El objetivo del trabajo es describir las características de las unidades y equipos de ictus en España.
Estudio transversal basado en un cuestionario ad hoc, diseñado por 5 expertos y dirigido a los ...neurólogos responsables de las unidades de ictus (UI) y los equipos de ictus (EI) con al menos un año de funcionamiento.
Participaron 43 UI (61% del total) y 14 EI. La media (±DE) de neurólogos adscritos a las UI/EI fue de 4±3. El 98% de las UI frente al 38% de los EI cuentan con neurólogo de guardia 24h los 365 días. Disponen de enfermería especializada un 98% de las UI frente al 79% de los EI, de médico rehabilitador un 81% frente al 71% y de trabajador social un 86% frente al 71%. La mayoría de las UI (80%) tienen 4-6 camas con monitorización continua no invasiva. El número medio de camas no monitorizadas de las UI es de 14±8 y de 12±7 en los EI. La estancia media de los pacientes en las camas monitorizadas de las UI es de 3±1 días. Todas las UI y el 86% de los EI pueden realizar trombólisis intravenosa; el 81% de las UI y el 21% de los EI pueden realizar trombectomía mecánica y el resto de los centros tiene posibilidad de derivación. El 44% de las UI dispone de un sistema de teleictus, que da servicio a 4±3 centros. La actividad se recoge sistemáticamente en el 77% de las UI y en el 50% de los EI, pero su cumplimentación es <75% en un 25% de los casos.
La mayoría de las UI y de los EI cumple las recomendaciones actuales. Para seguir mejorando la atención del paciente, resulta necesario optimizar el registro sistemático de su actividad.
The aim of this work is to describe the characteristics of stroke units and stroke teams in Spain.
We performed a cross-sectional study based on an ad hoc questionnaire designed by 5 experts and addressed to neurologists leading stroke units/teams that had been operational for ≥ 1 year.
The survey was completed by 43 stroke units (61% of units in Spain) and 14 stroke teams. The mean (SD) number of neurologists assigned to each unit/team is 4±3. 98% of stroke units (and 38% of stroke teams) have a neurologist on-call available 24hours, 365 days. 98% of stroke units (79% of stroke teams) have specialised nurse, 95% of units (71% of stroke teams) auxiliary personnel, 86% of units (71% of stroke teams) social worker, 81% of stroke units (71% of stroke teams) have a rehabilitation physician and 81% of stroke units (86% of stroke teams) a physiotherapist. Most stroke units (80%) have 4-6 beds with continuous non-invasive monitoring. The mean number of unmonitored beds is 14 (8) for stroke units and 12 (7) for stroke teams. The mean duration of non-invasive monitoring is 3 (1) days. All stroke units and 86% of stroke teams have intravenous thrombolysis available, and 81% of stroke units and 21% of stroke teams are able to perform mechanical thrombectomy, whereas the remaining centres have referral pathways in place. Telestroke systems are available at 44% of stroke units, providing support to a mean of 4 (3) centres. Activity is recorded in clinical registries by 77% of stroke units and 50% of stroke teams, but less than 75% of data is completed in 25% of cases.
Most stroke units/teams comply with the current recommendations. The systematic use of clinical registries should be improved to further improve patient care.
Summary
The study aimed to achieve expert consensus to optimize secondary fracture prevention in Spain. Relevant gaps in current patient management were identified. However, some aspects were ...considered difficult to apply. Future efforts should focus on those items with greatest divergences between importance and feasibility.
Purpose
To establish a Spanish multidisciplinary expert consensus on secondary fracture prevention.
Methods
A two-round Delphi consensus was conducted, guided by a Scientific Committee. The 43-item study questionnaire was designed from a literature review and a subsequent multidisciplinary expert group (
n
= 12) discussion. The first-round questionnaire, using a 7-point Likert scale, assessed the experts’
opinion
of the current situation, their
wish
for items to happen, and their
prognosis
that items would be implemented within 5 years. Items for which consensus was not achieved were included in the second round. Consensus was defined as ≥ 75% agreement or ≥ 75% disagreement. A total of 102 experts from 14 scientific societies were invited to participate.
Results
A total of 75 (response rate 73.5%) and 69 (92.0%) experts answered the first and second Delphi rounds, respectively. Participants mean age was 51.8 years standard deviation (SD): 10.1 years; being 24.0% rheumatologists, 21.3% primary care physicians, 14.7% geriatricians, 8.0% internal medicine specialists, 8.0% rehabilitation physicians, and 8.0% gynecologists. Consensus was achieved for 79.1% of items (wish, 100%; prognosis, 58.1%). Effective secondary prevention strategies identified as requiring improvement included: clinical report standardization, effective hospital primary care communication (telephone/mail and case managers), health-related quality of life (HRQoL) questionnaires use, and treatment compliance monitoring (prognosis agreement 33.3%, 47.8%, 18.8%, and 55.1%, respectively).
Conclusion
A consensus was reached by health professionals in their wish to implement strategies to optimize secondary fracture prevention; however, they considered some difficult to apply. Efforts should focus on those items with currently low application and those with greatest divergence between wish and prognosis.
OBJECTIVESTo review the literature on validated tools for measuring patient-reported outcomes (PROs) in psoriasis in Spain. To evaluate the psychometric properties of the tools and describe the ...results of their practical application. MATERIAL AND METHODSSystematic review of studies validating or using instruments for assessing PROs in Spanish patients with psoriasis. Literature searches were performed in international (PubMed/Medline) and Spanish (Medes, Ibecs) databases. We also searched databases of instruments for measuring PROs (BiblioPRO, PROQOLID). The review included studies published in English or Spanish up to January 9, 2017. We also checked the reference lists of the key publications identified. The quality of the questionnaires was evaluated based on their psychometric properties (construct, transcultural adaptation, reliability, validity, feasibility, and sensitivity to change). RESULTSEighteen publications were included. Six articles described the validation of Spanish versions of 5 PROs tools: 4 health-related quality of life (HRQoL) questionnaires specific to psoriasis and dermatologic diseases and 1 questionnaire specific to satisfaction with treatment. Our assessment of the HRQoL tools' psychometric properties showed that the PSO-LIFE questionnaire received the highest scores, although specific properties varied from instrument to instrument. The 12 remaining articles were observational studies that used the validated instruments. In use, these tools detected the high impact of psoriasis on HRQoL, especially in young female patients with severe disease. CONCLUSIONSWe identified 5 specific instruments validated in Spain for scoring PROs in patients with psoriasis. The tools' psychometric properties vary, and it is essential to understand their strengths and weaknesses when selecting the right one for each situation. In use, these questionnaires are able to detect the high impact of psoriasis on patients' HRQoL. PROs provide useful information to complement routine clinical findings in psoriasis and may contribute to improving disease management.
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