Summary
Aims: To assess the evolution of type 2 diabetes mellitus (T2DM) quality indicators in primary care centers (PCC) as part of the Group for the Study of Diabetes in Primary Care (GEDAPS) ...Continuous Quality Improvement (GCQI) programme in Catalonia.
Methods: Sequential cross‐sectional studies were performed during 1993–2007. Process and outcome indicators in random samples of patients from each centre were collected. The results of each evaluation were returned to each centre to encourage the implementation of correcting interventions. Sixty‐four different educational activities were performed during the study period with the participation of 2041 professionals.
Results: Clinical records of 23,501 patients were evaluated. A significant improvement was observed in the determination of some annual process indicators: HbA1c (51.7% vs. 88.9%); total cholesterol (75.9% vs. 90.9%); albuminuria screening (33.9% vs. 59.4%) and foot examination (48.9% vs. 64.2%). The intermediate outcome indicators also showed significant improvements: glycemic control HbA1c ≤ 7% (< 57 mmol/mol); (41.5% vs. 64.2%); total cholesterol ≤ 200 mg/dl (5.17 mmol/l); (25.5% vs. 65.6%); blood pressure ≤ 140/90 mmHg; (45.4% vs. 66.1%). In addition, a significant improvement in some final outcome indicators such as prevalence of foot ulcers (7.6% vs. 2.6%); amputations (1.9% vs. 0.6%) and retinopathy (18.8% vs. 8.6%) was observed.
Conclusions: Although those changes should not be strictly attributed to the GCQI programme, significant improvements in some process indicators, parameters of control and complications were observed in a network of primary care centres in Catalonia.
Summary
Background
Older subjects with type 2 diabetes mellitus (T2DM) have differential characteristics compared with middle‐aged or younger populations, and require tailored management of the ...disease.
Aims
To evaluate how clinical characteristics, degree of control of glycaemia and cardiovascular risk factors, presence of chronic complications and treatments differ between older T2DM patients and younger adults.
Methods
Cross‐sectional study using data from a population‐based electronic database. We retrieved data from 318,020 patients ≥ 30 years diagnosed with T2DM, attended during 2011 in primary care centres in Catalonia, Spain. We performed descriptive and comparative analyses stratified by gender and age subgroups: ≤ 65, 66–75, 76–85 and >85 years.
Results
Both men and women across older age subgroups (> 65 years) had longer diabetes duration than younger adults (8.0 vs. 5.6 in men and 8.4 vs. 6.9 years in women; p < 0.001), but better glycaemic control (mean glycated haemoglobin 7.1 vs. 7.7 in men and 7.1 vs. 7.4 in women; p < 0.001), and better combined control of different cardiovascular risk factors (p < 0.001). Moreover, older patients were more likely to achieve glycaemic targets irrespective of having cardiovascular disease. The use of oral antidiabetics decreased with increasing age, and insulin in monotherapy was more frequently prescribed among patients in the older age subgroups. Diabetes‐related complications were more frequent in men of all group ages. In the older age subgroups, patients of both sexes had a longer duration of T2DM but better glycaemic control. In this context, the prevalence of diabetic retinopathy decreased unexpectedly with increasing age.
Conclusion
Control of glycaemia and cardiovascular risk factors was better among older T2DM patients. There is a need for prospective studies to quantify the weight of risk factors in each complication to adapt the therapeutic and care approaches in elderly people.
Abstract Background and objective Statin-associated autoimmune myopathy (SAAM) with anti-HMGCR antibodies has recently been described. Several specific immunoassays are in use to detect HMGCR ...antibodies. In the course of systematic autoantibody screening we recognized a new distinct IFL staining pattern on rat liver sections that regularly coincided with anti-HMGCR antibodies. In this study we investigated whether this new IFL pattern is specifically associated to statin-associated autoimmune myopathy and corresponds to anti-HMGCR antibodies. Patients and methods Twenty-three patients positive for anti-HMGCR antibodies (14 diagnosed with SAAM) were investigated for anti-HMGCR antibodies by two ELISA assays and confirmed by immmunoblot. HMGCR associated liver IFL pattern (HALIP) was detected by indirect IFL and the reactivity against HMGCR was confirmed by immunoabsorption using purified human HMGCR antigen. 90 patients with other autoimmune diseases and 45 non-autoimmune statin treated patients were studied as controls. Results 21 out of 23 (91%) anti-HMGCR positive patients were HALIP positive. The staining was completely and specifically removed by immunoabsorption with human purified HMGCR. None of the control sera from autoimmune patients or non-autoimmune statin treated subjects was positive for HALIP. Statistical concordance between HALIP and anti-HMGCR antibody specific tests was 98.7%, kappa 0.95. Conclusions A new and distinct IFL staining pattern (HALIP) is associated to HMGCR associated myopathy. Absorption and concordance studies indicate that the antigen recognized in the liver by HALIP is HMGCR or a closely related protein. Awareness of this new pattern can help to detect HMGCR autoantibodies in statin treated patients tested for autoimmune serology.
Resumen Objetivo Explorar percepciones y expectativas de estudiantes de los cursos 1.°, 3.° y 5.° de las facultades de medicina sobre medicina de familia y comunitaria (MFyC) y atención primaria ...(AP). Diseño Estudio observacional con administración de un cuestionario en 2 cortes transversales con un intervalo de 2 años. Emplazamiento Facultades de medicina españolas. Participantes Estudiantes de los cursos 1.°, 3.° y 5.° de 22 facultades (1.a fase) y 15 en la segunda. Mediciones principales Cuestionario autocumplimentado administrado durante el primer trimestre de los cursos 2009-2010 y 2011-2012. Consta de 70 ítems en 3 bloques: percepciones sobre MFyC (19 ítems), formación en MFyC (26 ítems), expectativas y preferencias (25 ítems), más 13 ítems específicos para alumnos de 3.° y 5.°. La mayoría se respondían según una escala Likert (de 1 a 6). Resultados En la 1.a fase se obtuvieron 5.299 cuestionarios y 3.869 en la segunda. Los estudiantes perciben la MFyC y AP como un ámbito esencial del sistema sanitario y de ejercicio profesional pero con escaso atractivo científico-técnico. El 87% consideran necesaria y obligatoria la formación en MFyC y que debería iniciarse en el 3.er curso. Prefieren las especialidades médicas hospitalarias (88-89%) seguidas de las quirúrgicas y la pediatría. La MFyC es preferida por el 37-39%. Al iniciar la carrera solamente entre el 24 y el 28% de los estudiantes tienen una decisión clara sobre la especialidad que van a escoger. Conclusiones La MFyC y la AP son ámbitos esenciales y han de formar parte de los currículum pero tienen una baja consideración científica.
Analizar el grado de seguimiento realizado por médicos, enfermeras y otros profesionales de la salud sobre los enfermos consumidores de fármacos psicotropos.
Estudio observacional retrospectivo en el ...que se seleccionó a pacientes de ambos sexos mayores de 15 años, con consumo de fármacos psicotropos y visitados un mínimo de 10 veces por la misma unidad básica de atención médico-enfermera (UBA). Se estudió su seguimiento durante 2 períodos de un año: el primer año después del diagnóstico y el período octubre de 2001-octubre de 2002.
Atención primaria en el Área Básica de Salud (ABS) Raval Sud, Barcelona.
Se revisaron 730 historiales de pacientes, de los cuales 200 (27%) cumplieron criterios de inclusión.
El diagnóstico más frecuente fue el trastorno de ansiedad-depresión (58%), y destacaba que un 14,5% de los pacientes no tenían un diagnóstico registrado. El 35,5% correspondió a pacientes que recibieron más de un fármaco y el grupo farmacológico más frecuente fue el de las benzodiacepinas (60,4%). Se detectaron diferencias significativas en el número de controles entre los 2 períodos, y entre las diferentes UBA. La mediana de la diferencia de períodos fue −0,5 y su intervalo de confianza del 95%, −1,0; se evidencia que el grado de control disminuye con el tiempo.
En estos pacientes se observa poco control en su seguimiento, lo que indica la necesidad de crear unos objetivos y unos protocolos claros dirigidos al equipo médico-enfermera, para así facilitar el tratamiento del paciente con problemas de salud mental.
To analyse the degree of monitoring by doctors, nurses, and other health professionals of patients taking psychotropic medication.
Retrospective, observational study of patients of both sexes and over 15 years old, who took psychotropic medication and had attended a minimum of ten times the same doctor-nurse primary care unit (PCU). Their monitoring during 2 year-long periods was studied: a first period (the first year after diagnosis) and a second period from October 2001 to October 2002.
Primary care in the Raval Sud District, Barcelona, Spain.
A total of 730 clinical histories were reviewed, of which 200 (27%) met inclusion criteria.
The most common diagnosis was anxiety-depression disorder (58%), and 14.5% of patients had no recorded diagnosis. 35.5% were patients taking more than one medicine. The most common drug group was the benzodiazepines (60.4%). Significant differences in the number of controls were found between the 2 periods and between different PCUs. The mean difference between periods was −0.5, with 95% CI at −1.0: clearly the degree of monitoring drops over time.
These patients’ follow-up was not monitored well, which poses the need to create clear aims and protocols for the doctor-nurse team, to thus assist the treatment of patients with mental health problems.
Demostrar la utilidad de sencillos instrumentos geriátricos como predictors del deterioro de las actividades básicas de la vida diaria (ABVD) o pérdida de calidad de vida al año en ancianos con un ...estado de salud previo aparentemente bueno, para poder ser aplicado en atención primaria de la salud (APS)
Estudio prospectivo
Centro de atención primaria urbano
Muestra sistemática de 100 ancianos con edad=75 años, índice de Barthel (IB)=90, escala de Karnofsky (EK)=70 y ausencia de proceso neoplásico.
Se les aplicó un protocolo de valoración geriátrica integral que incluía variables biopsicosociales y funcionales. Tras 12 meses se revaloraron las ABVD (IB) y la calidad de vida (EK).Se realizó la estimación de las odds ratio (OR) de asociación mediante modelos de regresión logística múltiples
Las alteraciones en las pruebas de cognición (test de Pfeiffer < 2) y en las actividades instrumentales de la vida diaria (AIVD) (índice de Lawton IL < 7) se mostraron predictoras del deterioro en las ABVD (OR=4,66; intervalo de confiaza IC, 1,33–16,22, y OR=4,89; IC, 1,65–14,48, respectivamente).Las alteraciones en las AIVD (IL < 7) y las alteraciones en las pruebas de rendimiento (test de Guralnik abreviado <4) se mostraron predictores del deterioro de la calidad de vida (OR=4,31; IC, 1,62–11,44, y OR=7,41; IC, 1,54–35,62,respectivamente)
En APS, los instrumentos de valoración geriátrica centrados en las AIVD, la cognición y las pruebas de rendimiento predicen el deterioro en las ABVD y en calidad de vida
The goal of this work was to prove the usefulness of simple standard geriatrics tools as a predictors of basic daily activities or quality of life decline in one year in older patients apparent healthy to apply in primary care
Prospective study of a randomized sample of 100 patients
Urban primary care center
A systematic sample of 100 patients of 75 years old or older, with Barthel index =90, Karnofsky scale =70 and without any neoformation process evaluated prospectively
A comprehensive geriatric assessment was done that include: physical performance, neural-psychologist performance, organic assessment, social assessment. After 12 month were assessed again basic activities of daily living (Barthel) and quality of life (Karnofsky). To estimate the odds ratio (OR) of association we used logistic regression models
The alterations in cognition trials (Pfeiffer>2) and in instrumentals activities of daily living (Lawton <7) showed predictors about decline in basic activities of daily living (OR=4.66; CI, 1.33–16.22), (OR=4.89; CI, 1.65–14.48). The alterations in instrumentals activities of daily living (Lawton <7) and in performance tests (abbreviated Guralnik test < 4) showed predictors about decline in quality of life (OR=4.31; CI, 1.62–11.44), (OR=7.41; CI,1.54–35.62)
In primary care geriatric assessment tools based in instrumentals activities of daily living, cognition and performance tests predict decline in basic activities of daily living and quality of life
Given the low effectiveness of 24 hours determination of urinary albumin excretion (UAE) for the diagnosis of diabetic nephropathy in primary care, we aimed at evaluating the albumin: creatinine ...ratio (ACR) in the first voided morning urine sample as a diagnostic tool in this setting.
214 patients with type 2 diabetes were studied. ACR and UAE were compared with correlation and lineal regression analyses. A receiver operating characteristic (ROC) curve analysis was performed to determine the discriminatory value for diagnosis of diabetic nephropathy.
The correlation coefficient between ACR and UAE was 0.93 (p<0.01) and the ROC curve analysis showed a value of 2.4 g/mol for women and 1.4 g/mol for men.
ROC curve analysis reveals that ACR is a useful method for diagnosing diabetic nephropathy, although the discriminatory value depends on sex.
The goal of this work was to prove the usefulness of simple standard geriatrics tools as a predictors of basic daily activities or quality of life decline in one year in older patients apparent ...healthy to apply in primary care.
Prospective study of a randomised sample of 100 patients.
Urban primary care center.
A systematic sample of 100 patients of 75 years old or older, with Barthel index > or =90, Karnofsky scale > or =70 and without any neoformation process evaluated prospectively.
A comprehensive geriatric assessment was done that include: physical performance, neural-psychologist performance, organic assessment, social assessment. After 12 month were assessed again basic activities of daily living (Barthel) and quality of life (Karnofsky). To estimate the odds ratio (OR) of association we used logistic regression models.
The alterations in cognition trials (Pfeiffer >2) and in instrumental activities of daily living (Lawton <7) showed predictors about decline in basic activities of daily living (OR=4.66; CI, 1.33-16.22), (OR=4.89; CI, 1.65-14.48). The alterations in instrumental activities of daily living (Lawton <7) and in performance tests (abbreviated Guralnik test <4) showed predictors about decline in quality of life (OR=4.31; CI, 1.62-11.44), (OR=7.41; CI, 1.54-35.62).
In primary care geriatric assessment tools based in instrumental activities of daily living, cognition and performance tests predict decline in basic activities of daily living and quality of life.
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