Scientia, Dipòsit d’Informació Digital del Departament de Salut
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Evidence Gaps and Lessons in the Early Detection of Atrial Fibrillation: A Prospective Study in a Primary Care Setting (PREFATE Study)
Get PDFArrhythmias; Atrial fibrillation; Cardiac/diagnosis; Heart rate determination;
Echocardiography/Statistics and numerical data; Electrocardiography; ambulatory/standards;
Diagnostic techniques and procedures; Clinical risk scores; Device detected atrial fibrillation;
Ischemic strokeArritmias; Fibrilación auricular; Cardíaco/diagnóstico; Determinación de la frecuencia cardíaca; Ecocardiografía/Estadísticas y datos numéricos; Electrocardiografía; ambulatoria/estándares; Técnicas y procedimientos diagnósticos; Puntuaciones de riesgo clínico; Fibrilación auricular detectada por dispositivo; Ictus isquémicoArrítmies; Fibril·lació auricular; Determinació de la freqüència cardíacaBackground/Objectives: In Europe, the prevalence of AF is expected to increase 2.5-fold over the next 50 years with a lifetime risk of 1 in 3-5 individuals after the age of 55 years and a 34% rise in AF-related strokes. The PREFATE project investigates evidence gaps in the early detection of atrial fibrillation in high-risk populations within primary care. This study aims to estimate the prevalence of device-detected atrial fibrillation (DDAF) and assess the feasibility and impact of systematic screening in routine primary care. Methods: The prospective cohort study (NCT05772806) included 149 patients aged 65-85 years, identified as high-risk for AF. Participants underwent 14 days of cardiac rhythm monitoring using the Fibricheck® app (CE certificate number BE16/819942412), alongside evaluations with standard ECG and transthoracic echocardiography. The primary endpoint was a new AF diagnosis confirmed by ECG or Holter monitoring. Statistical analyses examined relationships between AF and clinical, echocardiographic, and biomarker variables. Results: A total of 18 cases (12.08%) were identified as positive for possible DDAF using FibriCheck® and 13 new cases of AF were diagnosed during follow-up, with a 71.4-fold higher probability of confirming AF in FibriCheck®-positive individuals than in FibriCheck®-negative individuals, resulting in a post-test odds of 87.7%. Significant echocardiographic markers of AF included reduced left atrial strain (<26%) and left atrial ejection fraction (<50%). MVP ECG risk scores ≥ 4 strongly predicted new AF diagnoses. However, inconsistencies in monitoring outcomes and limitations in current guidelines, particularly regarding AF burden, were observed. Conclusions: The study underscores the feasibility and utility of AF screening in primary care but identifies critical gaps in diagnostic criteria, anticoagulation thresholds, and guideline recommendations.This research was funded by the Department of Health of the Generalitat of Catalonia in its Strategic Plan in Research and Innovation in Health (PERIS), on the 2021 call (expedient file SLT/21/000027)
Smoking, Colchicine and Postoperative Outcomes in Thoracic Surgery: Post Hoc Analysis of the COP-AF Randomized Controlled Trial
Get PDFSmoking; Colchicine; Thoracic surgeryTabaquisme; Colchicina; Cirurgia toràcicaTabaquismo; Colchicina; Cirugía torácicaBackground To determine, among patients who underwent major noncardiac thoracic surgery, the association between smoking and perioperative atrial fibrillation (AF) and myocardial injury after noncardiac surgery (MINS), and whether the effect of colchicine use on these outcomes varied by smoking status. Methods This study is a subgroup analysis of the Colchicine for the Prevention of Perioperative Atrial Fibrillation (COP-AF) randomized clinical trial. A total of 3209 participants who underwent major noncardiac thoracic surgery were randomized to receive colchicine, 0.5 mg twice daily, or identical placebo, for 10 days starting 2-4 hours before surgery. The co-primary outcomes were clinically significant perioperative AF and MINS during the 14-day follow-up. Results A total of 687 (21.4%) were current smokers, 1577 (49.1%) were former smokers, and 945 (29.5%) were never smokers. AF occurred in 7.7%, 7.6%, and 5.3%, and MINS occurred in 21.0%, 19.7%, and 17.6% of current, former, and never smokers, respectively. Compared to never smokers, the adjusted hazard ratio for AF was 1.72 (95% confidence interval [CI] 1.07-2.77, P = 0.02) in current smokers and 1.46 (95% CI 0.99-2.16, P = 0.06) in former smokers, and the adjusted hazard ratio for MINS was 1.16 (95% CI 0.87-1.54, P = 0.32) in current smokers and 1.02 (95% CI 0.81-1.28, P = 0.88) in former smokers. No interaction occurred between smoking status and colchicine allocation for AF (interaction P, 0.82) or MINS (interaction P, 0.08). Conclusions Current smoking was associated with a small but increased risk of perioperative AF but not MINS after thoracic surgery. The effect of colchicine use on either outcome was not modified by smoking status. Clinical Trial Registration NCT03310125.This post hoc analysis did not receive specific funding. However, the main COP-AF trial was supported by the following: Canadian Institutes of Health Research (PJT-162458, PJT-165842); Accelerating Clinical Trials Consortium; Innovation Fund of the Alternative Funding Plan for the Academic Health Sciences Centres of Ontario; Population Health Research Institute; Hamilton Health Sciences; Division of Cardiology at McMaster University, Canada; Hanela Foundation, Switzerland; and General Research Fund (14121720), Research Grants Council, Hong Kong (14121720)
Regió Sanitària Alt Pirineu i Aran: memòria 2024
No full textSistema sanitari públic; Activitat assistencial; MemòriaSistema sanitario público; Actividad asistencial; MemoriaPublic health system; Healthcare activity; MemoryAquest 2024 ha estat un any intens i ple de revolts, però en què hem impulsat grans projectes per continuar transformant el sistema sanitari. En aquest sentit, intensificar la col·laboració entre nivells assistencials i entre entitats proveïdores ha esdevingut una estratègia clau per guanyar en eficiència i sostenibilitat. L’atenció primària continua treballant per incrementar la seva resolució i accessibilitat. Com a mostra d’això, els equips de la regió sanitària atenen ja les gairebé 780 persones que viuen a les residències de gent gran, un col·lectiu amb un alt índex de malalties cròniques. També, a la primària hem posat en marxa el programa interdisciplinari APAFit, a fi de millorar l’estil de vida de les persones amb patologies cròniques complexes. Pel que fa l’àmbit hospitalari, mantenim l’aposta per apropar l’atenció al territori. La nova Xarxa Hospitalària Lleida-Pirineu té com a finalitat promoure la col·laboració entre hospitals de diferents nivells per atendre la ciutadania més a prop de casa. En aquest context, l’HUAV i l’HCP han implementat el projecte Tele-UCI Territorial, que permet que els pacients crítics o semicrítics monitorats a urgències o
a planta d’hospitalització al Pallars puguin ser valorats a distància per metges intensivistes de l’HUAV. Continuem impulsant accions per fidelitzar talent al territori. Celebrem especialment la pròxima implantació, el curs 2025-2026, del grau en Infermeria a l’Alt Pirineu i Aran, una fita a la qual hem dedicat grans esforços i que ens permetrà oferir formació adaptada a les necessitats del territori i retenir professionals a les nostres comarques. S'ha actualitzat el conveni en atenció a les urgències i les emergències entre Catalunya i l’Aragó, que impacta de ple en la nostra regió sanitària, així com l’inici de les gestions per traspassar la gestió de la Fundació Sant Hospital a una empresa de
titularitat pública
Lenvatinib Plus Pembrolizumab and Chemotherapy Versus Chemotherapy in Advanced Metastatic Gastroesophageal Adenocarcinoma: The Phase III, Randomized LEAP-015 Study
Get PDFLenvatinib; Chemotherapy; Advanced metastatic gastroesophageal adenocarcinomaLenvatinib; Quimioteràpia; Adenocarcinoma gastroesofàgic metastàtic avançatLenvatinib; Quimioterapia; Adenocarcinoma gastroesofágico metastásico avanzadoPurpose: The phase III randomized open-label LEAP-015 study (ClinicalTrials.gov identifier: NCT04662710) evaluated first-line lenvatinib plus pembrolizumab and chemotherapy versus chemotherapy for advanced metastatic gastroesophageal adenocarcinoma.
Methods: Eligible participants 18 years and older with untreated human epidermal growth factor receptor 2-negative locally advanced unresectable or metastatic gastroesophageal adenocarcinoma were randomly assigned 1:1 to induction with oral lenvatinib 8 mg once daily plus pembrolizumab 400 mg intravenously once every 6 weeks (×2) and investigators' choice of capecitabine and oxaliplatin once every 3 weeks (×4) or fluorouracil, leucovorin, and oxaliplatin once every 2 weeks (×6) and consolidation with lenvatinib plus pembrolizumab, or chemotherapy. Dual primary end points were progression-free survival (PFS) and overall survival (OS) in participants with PD-L1 combined positive score (CPS) ≥1 and all participants. Secondary end points included objective response rate (ORR) and duration of response.
Results: Of 880 participants randomly assigned, 443 received lenvatinib plus pembrolizumab and 437 received chemotherapy. The median follow-ups were 32.2 months (range, 19.0-41.7) in participants with PD-L1 CPS ≥1 and 31.8 months (19.0-41.7) in all participants. At interim analysis, PFS was statistically significant with lenvatinib plus pembrolizumab versus chemotherapy in participants with PD-L1 CPS ≥1 (median, 7.3 v 6.9 months; hazard ratio [HR], 0.75 [95% CI, 0.62 to 0.9]; P = .0012) and all participants (median, 7.2 v 7.0 months; HR, 0.78 [95% CI, 0.66 to 0.92]; P = .0019). The ORR was 59.5% versus 45.4% in participants with PD-L1 CPS ≥1 and 58.0% versus 43.9% in all participants, P < .0001 for both. At final analysis, OS was not statistically significant in participants with PD-L1 CPS ≥1 (median, 12.6 v 12.9 months; HR, 0.84 [95% CI, 0.71 to 1.00]; P = .0244; P value boundary = .0204). Grade ≥3 drug-related adverse event rates were 65% versus 49%.
Conclusion: Lenvatinib plus pembrolizumab and chemotherapy versus chemotherapy provided a statistically significant improvement in PFS in advanced unresectable or metastatic gastroesophageal carcinoma at interim analysis although the clinical significance of this difference seems to be limited. No significant improvement occurred in OS in participants with PD-L1 CPS ≥1.Supported by Merck Sharp & Dohme LLC, a subsidiary of Merck & Co, Inc, Rahway, NJ, and Eisai Inc, Nutley, NJ
Identification of strengths and weaknesses of the healthcare system for persons living with rare diseases in Catalonia (Spain), and recommendations to improve its comprehensive attention: the "acERca las enfermedades raras" project
Get PDFComprehensive care; Focus group; Healthcare system; Patient journey; Person living with a rare disease; Rare diseasesAtención integral; Grupo focal; Persona que vive con una enfermedad raraAtenció integral; Grup focal; Persona que viu amb una malaltia raraComprehensive care; Person living with a rare disease; Rare diseasesRare diseases (RDs) are a heterogeneous group of complex and low-prevalence conditions in which the time to establish a definitive diagnosis is often too long. In addition, for most RDs, few to no treatments are available and it is often difficult to find a specialized care team.
The project "acERca las enfermedades raras" (in English: "bringing RDs closer") is an initiative primary designed to generate a consensus by a multidisciplinary group of experts to detect the strengths and weaknesses in the public healthcare system concerning the comprehensive care of persons living with a RD (PLWRD) in the region of Catalonia, Spain, where a Network of Clinical Expert Units (Xarxa d'Unitats de Expertesa Clínica or XUEC) was created and is being implemented since 2015. The additional primary aim was to propose recommendations to solve or improve the limitations found.
A task force of 13 participants with multidisciplinary expertise on RDs completed a questionnaire and participated in two focus groups. A document was drafted with an item series of strengths and weaknesses of the healthcare system regarding the care of PLWRD, and a set of proposals or recommendations to overcome the problems identified.
The Catalan Government healthcare model of XUECs for the comprehensive care for RDs is currently valid and adapted to the needs of PLWRD and their families since its strategic optimal and operational framework, and it is aligned with the European Reference Networks (ERNs) thematic areas. The problems found in the current healthcare model were grouped into ten main areas: (1) the healthcare model for RDs; (2) coordination with primary healthcare providers and other tertiary and secondary hospitals; (3) access to and coordination with non-medical services; (4) the role of case manager in the XUEC; (5) genetic diagnosis; (6) undiagnosed patients; (7) treatments; (8) referring process, continuous follow-up, and transition from pediatric to adult centers; (9) research and education for professionals; and (10) associations of PLWRD and their families (patients' advocacy). The need for more resources was currently detected as the common factor for most of them. Ten key recommendations to improve the healthcare system regarding RDs were postulated.
Catalonia has established a unique healthcare model for RDs in Spain, with clear strengths and advantages. However, after analyzing them, the experts suggested that new governmental political and administrative decisions are needed to ensure the efficient implementation of a healthcare plan for PLWRD in Catalonia, which could be applied to other regions and nations worldwide
Marc de l’experiència de pacient al sistema de salut de Catalunya
Get PDFExperiència de pacient (EXP); Qualitat; AvaluacióExperiencia de paciente (EXP); Calidad; EvaluaciónPatient Experience (EXP); Quality; EvaluationEXP is a key factor in service management
of health More and more research is being done for
see the impact, both from the side of the
patients as well as health professionals.
A summary of the main findings of these
studies provide contrasting arguments that us
explain the importance of incorporating EXP in
health management processes.EXP es un factor clave en la gestión de los servicios
de salud. Cada vez se hace más investigación por
ver su impacto, tanto desde la vertiente de los
pacientes como de los profesionales de la salud.
Un resumen de los principales hallazgos de éstos
estudios aportan argumentos contrastados que nos
explican la importancia de incorporar el EXP en
los procesos de gestión sanitaria.L’objectiu general del Marc d’Experiència és “promoure i impulsar la cultura de l’experiència de pacient al sistema de salut públic de Catalunya per millorar la qualitat dels serveis i l’atenció”. Això s’ha d’aconseguir mitjançant uns elements facilitadors tant en l’àmbit de sistema i d’entitats proveïdores, com dels professionals:
• Incorporar la perspectiva de pacient en els processos de millora, recerca o innovació tant dels serveis com de les tecnologies per a la salut.
• Incloure la perspectiva de pacient per conèixer les seves necessitats, percepcions i expectatives respecte els serveis de salut.
• Potenciar l’experiència de pacient en l’avaluació dels serveis de salut
Novetats en el nou protocol d'activitats preventives i de promoció de la salut a l'edat pediàtrica: créixer amb salut [fullet]
No full textProtocols mèdics; Promoció de la salut; CatalunyaProtocolos médicos; Promoción de la salud; CataluñaMedical protocols; Health promotion; CataloniaAquesta infografia resumeix els apartats més destacats del nou protocol d'activitats preventives i de promoció de la salut a l'edat pediàtrica: créixer amb salut
Atenció especialitzada ambulatòria: manual de notificació; registre del conjunt mínim bàsic de dades (CMBD)
No full textAtenció ambulatòria; Registres; VariablesOutpatient care; Records; VariablesAtención ambulatoria; Registros; VariablesL’objectiu principal de la revisió d’aquest document és tenir una eina de suport que descrigui el contingut del Registre des del punt de vista del professional dels serveis de documentació dels hospitals o d’altres entitats sanitariès que proveeixin atenció especialitzada en règim ambulatori. La informació del Registre des del punt de vista tècnic ha d’estar recollida en altres documents
Metodologia i eines per a projectes d’experiència de pacient
Get PDFBuenas prácticas; Experiencia de paciente; SaludGood practices; Patient experience; HealthExperiència de pacient (EXP); Qualitat; AvaluacióAquest document descriu el procés per avaluar l’experiència del pacient dins del sistema públic de Catalunya, implicant-hi professionals, institucions i usuaris, amb l'objectiu de millorar la qualitat dels serveis i l'atenció. A més, inclou un annex amb eines per a l’anàlisi i la millora de l’experiència del pacientEste documento describe el proceso para evaluar la experiencia del paciente dentro del sistema público de Cataluña, implicando a profesionales, instituciones y usuarios, con el objetivo de mejorar la calidad de los servicios y la atención. Además, incluye un anexo con herramientas para el análisis y la mejora de la experiencia del paciente.This document describes the process for evaluating the patient experience within the public system in Catalonia, involving professionals, institutions and users, with the aim of improving the quality of services and care. It also includes an annex with tools for analyzing and improving the patient experience
Guia de codificació de l’atenció geriàtrica: codificació de les síndromes geriàtriques i procediments; conjunt mínim bàsic de dades d’atenció intermèdia (CMBD-AI)
Get PDFAtenció geriàtrica; Conjunt mínim bàsic de dades d’atenció intermèdia; CMBD-AI;
Codificació de les síndromes geriàtriques.Atención geriátrica; Conjunto mínimo básico de datos de atención intermedia; CMBD-AI; Codificación de los síndromes geriátricosGeriatric care; Basic minimum set of intermediate care data; CMBD-AI; Coding of geriatric syndromesAquest document pretén facilitar les instruccions necessàries per unificar els conceptes quant a la utilització de la informació diagnòstica i també per a una correcta codificació d’aquesta. El document conté els diagnòstics més habituals atesos a l’atenció geriàtrica dins de l’àmbit de l’atenció intermèdia. Aquest document recull les instruccions de codificació de les principals síndromes geriàtriques i malalties neurodegeneratives que afecten les persones ateses en aquest àmbit. A cada apartat s’inclou el codi corresponent a la CIM-9-MC i la proposta de conversió a la CIM-10-MC