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Caballero-Villarraso J.,Hospital Universitario Reina Sofia | Villegas-Portero R.,Agencia de Evaluacion de Tecnologias Sanitarias de Andalucia AETSA | Rodriguez-Cantalejo F.,Hospital Universitario Reina Sofia
Atencion Primaria | Year: 2011

Objective: To compare portable coagulometer devices and conventional coagulometers. The clinical validity will be estimated via anticoagulation control (maintenance of therapeutic range), patient satisfaction, thrombotic or haemorrhagic events and mortality. Analytical validity will be studied in quality control terms. Design: Systematic review. Data sources: MEDLINE and EMBASE databases, CRD, Cochrane, EMEA, FDA, EuroScan and the ClinicalTrials.gov. Methods: Inclusion criteria were studied in patients on anticoagulation therapy who used portable coagulometer devices. In an additional undertaking, the comparison with lab references was looked for, in order to evaluate the effectiveness. The quality of selected studies was assessed according to CASPe check-list. As meta-analysis was not possible, a qualitative synthesis was made. Results: Four evaluation reports and 7 systematic reviews were selected (two of them with meta-analysis). After these, 22 original articles were included for this review and they had high or very high score for CASPe check-list (<7/10). Almost all of the studies found very high correlations between portable coagulometer devices and conventional coagulometers (r>90), and clinical advantages such as lower incidence of thromboembolism events. Three systematic reviews showed a lower mortality index. Conclusions: The analytical-validity related articles show that portable coagulometers have an equivalent effectiveness to conventional coagulometers. Studies that include patient-reported outcomes show that self-monitoring patients, by means of portable coagulometers, have better analytical measurement results and fewer rates of thromboembolic events. Survival was analysed in very few studies; nevertheless, all of these show lower mortality. Similarly, the minority of selected articles includes economic evaluations, although they suggest a better cost-effectiveness of portable coagulometers compared to the conventional mode. © 2009 Elsevier España, S.L. All rights reserved.

Gonzalez-Bueno J.,Hospital Universitario Virgen Del Rocio | Vega-Coca M.D.,Agencia de Evaluacion de Tecnologias Sanitarias de Andalucia AETSA | Rodriguez-Perez A.,Hospital Universitario Virgen Del Rocio | Toscano-Guzman M.D.,Hospital Universitario Virgen Del Rocio
Atencion Primaria | Year: 2016

Objective To assess the available scientific evidence regarding the efficacy of interventions aimed to enhance medication adherence in patients with multiple chronic conditions (PMCC). Design Overview of systematic reviews. Data sources The following databases were consulted (September 2013): Pubmed, EMBASE, the Cochrane Library, CRD and WoS to identify interventions aimed to enhance medication adherence in PMCC, or otherwise, patients with chronic diseases common in the PMCC, or polypharmacy. Study selection Systematic reviews of clinical trials focused on PMCC or similar were included. They should compare the efficacy of any intervention aimed to improve compliance to prescribed and self-administered medications with clinical practice or other interventions. Data extraction Information about the study population, nature of intervention and efficacy in terms of improved adherence was extracted. Results 566 articles were retrieved of which 9 systematic reviews were included. None was specifically focused on PMCC but considered patients with chronic diseases common in the PMCC, patients with more than one chronic disease and polypharmacy. The overall effectiveness of interventions was modest without relevant differences between behavioural, educational and combined interventions. Some components of these interventions including patient counselling and regimen simplification appear to be effective tools in improving adherence in this population group. Conclusion There is a large heterogeneity of interventions aimed to improve adherence with modest efficacy, none in PMCC. © 2013 Elsevier España, S.L.U.

Olry de Labry Lima A.,Campus Universitario Of Cartuja | Olry de Labry Lima A.,CIBER ISCIII | Epstein D.,University of York | Epstein D.,University of Granada | And 3 more authors.
Progresos de Obstetricia y Ginecologia | Year: 2012

Introduction: Cervical cancer is a major public health concern, causing approximately 10% of deaths from cancer in women worldwide. Objective: To determine the cost-effectiveness ratio of liquid-based cytology compared with the conventional cytological smear test for the detection of precancerous lesions of the cervix. Methods: A decision analysis model was constructed from the perspective of the public healthcare system. The alternatives compared were conventional and liquid-based cytology. The economic evaluation compared the short-term effectiveness and cost of testing. The measures of effectiveness used were the yield of the test (the proportion of correctly identified cases of cervical lesion in the population) and the «adjusted yield» (the proportion of cases identified minus false negatives). Data on diagnostic accuracy (sensitivity and specificity) and prevalence were obtained from a meta-analysis. Cost values were provided by the Virgen de las Nieves Hospital (Granada, Spain). To assess the uncertainty of the variables included in the model, several univariate and probabilistic sensitivity analyses were carried out. Results: The incremental cost of liquid-based cytology compared with conventional cytology was €919.49 for each cervical intraepithelial neoplasia (CIN1) or higher-stage lesion found. When the adjusted yield was used as the measure of effectiveness, the incremental cost-effectiveness ratio increased to €574 per lesion identified. © 2011 SEGO.

Martin-Lopez J.E.,Agencia de Evaluacion de Tecnologias Sanitarias de Andalucia AETSA | Molina-Lopez T.,Agencia de Evaluacion de Tecnologias Sanitarias de Andalucia AETSA
Cardiocore | Year: 2015

Introduction and objectives: Sudden death causes about 20,000 deaths per year in Spainand implantable cardioverter defibrillators (ICDs) are the main treatment. Despite of well-supported indications for use, great variability is detected when implanting these devicesto patients eligible. The aim of this paper is to analyze the use of ICDs in Europe and Spainand propose possible causes of the differences between them. Results: The rates of ICD implantation in Europe are highly heterogeneous and show a marked upward trend in most countries. Germany in 2012 is still the country with the largest number of devices with 324 implants per million inhabitants. In Spain in the same year a total of 4,216 DAI have been implanted over 161 centers with an implantation rate per million population of 91.2 implants/year. Conclusions: The employment rate of DAI increases in Europe and falls in Spain. The analy- sis of potential factors causing these differences can help to achieve optimum rates and standardize the use of ICDs in our community. © 2014 SAC. Published by Elsevier España, S.L.U.

Carlos-Gil A.M.,Agencia de Evaluacion de Tecnologias Sanitarias de Andalucia AETSA | Martinez-Pecino F.,Agencia de Evaluacion de Tecnologias Sanitarias de Andalucia AETSA | Molina-Linde J.M.,Agencia de Evaluacion de Tecnologias Sanitarias de Andalucia AETSA | Villegas-Portero R.,Agencia de Evaluacion de Tecnologias Sanitarias de Andalucia AETSA | And 5 more authors.
Revista Multidisciplinar de Gerontologia | Year: 2011

Objectives: To define predictors of frailty in the elderly. Methods: A systematic review had been conducted in order to obtain possible predictors of frailty in the elderly. The predictors were evaluated by an expert in older adult's care panel by three rounds of Delphi methodology. As a result of the systematic review of literature, 16 frailty predictors were obtained, and each predictor was included in a chapter. We have elaborated 271 questions about the frailty predictors. Every expert in the panel used a Likert scale from 1 to 9 (1 = predicted VERY BAD frailty, while 9 = predicted VERY GOOD frailty). Frailty predictors that obtained a median score higher than 7, were considered as good predictors. Results: Experts agreed that some variables were frailty predictors, by themselves and independently: mobility disorder, falls and limitation to basic activities of daily living, cognitive impairment, risk of pressure ulcers, multiple pathologies, socio-demographic features and environmental factors (there was consensus only regarding residence infrastructure), mood disorder (depression, anxiety and sleep disorders), and visual/hearing impairment. Conclusions: There is no single validated tool to identify frailty, though we found the possibility to group into 16 categories the possible predictors, and it would be helpful for the detection of frailty in the elderly.

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