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Barcelona, Spain

Mariotti G.,Hospital of Rovereto | Gentilini M.,Epidemiology Service | Dapor V.,Information Technology Service
International Journal of Medical Informatics | Year: 2013

Objective: Our main aim was to evaluate the ability of electronic feedback and of an electronic referral decision support system (ERSS) to enhance agreement between primary care physicians (PCPs) and specialists in priority assignment in clinics. Method: 62 PCPs used a ranking system of waiting times based on different categories of clinical priority called 'Homogeneous Waiting Groups' (HWGs), which was also used by specialists to assign a priority category for each patient. From the year 2001, all PCPs had to use a paper-based manual (group 1); instead from 2008, specialists began to use a computer-based tool, whereby the priority category reassigned to each patient by specialists promptly appeared on PCPs' computers (group 2). During the course of 2010, the manual was incorporated in ERSS and was used by a subgroup of PCPs (group 3). Agreement between PCPs and specialists' priority assignments was evaluated by the kappa statistic. Results: In group 1, the kappa statistic was 0.564 (95% CI=0.526-0.602); in group 2, the kappa statistic was 0.668 (95% CI=0.619-0.716); whereas in group 3 (that used ERSS) a very high kappa statistic emerged of 0.883 (95% CI=0.854-0.912). There was a significant difference in the proportion of agreement among the three groups (χ2=182.5, 2df, p<.0001). A significant difference in statistics was also observed in the proportion of priority levels used by PCPs over the years. Conclusions: Our results emphasize the positive effect of feedback and ERSS for improving referral activity and agreement between PCPs and specialists. © 2013 Elsevier Ireland Ltd.

Arnau B.,Obstetrics and Gynecology Service | Jovell E.,Epidemiology Service | Redon S.,Obstetrics and Gynecology Service | Canals M.,Obstetrics and Gynecology Service | And 2 more authors.
Acta Obstetricia et Gynecologica Scandinavica | Year: 2013

We investigated the efficacy of 5% lidocaine 25 mg-prilocaine 25 mg/g cream (EMLA®) applied to the uterine cervix for reducing pain during diagnostic or operative hysteroscopy, using a visual analogue scale (VAS) for pain in a prospective randomized, non-blinded, controlled study in 92 successive patients. Patients were randomized to either 3 mL of EMLA cream or 3 mL of ultrasound gel (placebo), placed endocervically and exocervically, 10 min before hysteroscopy. Intensity of pain was evaluated immediately after the procedure using a 10-cm VAS. No differences were found between the two groups (p = 0.07). The number of women who wished to stop the procedure was significantly lower in the EMLA group compared with the control group (p = 0.013). We concluded that topical instillation of EMLA does not decrease pain during hysteroscopy, but does reduce a desire to abandon the procedure. © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

Calori G.,San Raffaele Scientific Institute | Lattuada G.,San Raffaele Scientific Institute | Lattuada G.,University of Milan | Ragogna F.,San Raffaele Scientific Institute | And 9 more authors.
Hepatology | Year: 2011

A fatty liver, which is a common feature in insulin-resistant states, can lead to chronic liver disease. It has been hypothesized that a fatty liver can also increase the rates of non-hepatic-related morbidity and mortality. Therefore, we wanted to determine whether the fatty liver index (FLI), a surrogate marker and a validated algorithm derived from the serum triglyceride level, body mass index, waist circumference, and γ-glutamyltransferase level, was associated with the prognosis in a population study. The 15-year all-cause, hepatic-related, cardiovascular disease (CVD), and cancer mortality rates were obtained through the Regional Health Registry in 2011 for 2074 Caucasian middle-aged individuals in the Cremona study, a population study examining the prevalence of diabetes mellitus in Italy. During the 15-year observation period, 495 deaths were registered: 34 were hepatic-related, 221 were CVD-related, 180 were cancer-related, and 60 were attributed to other causes. FLI was independently associated with the hepatic-related deaths (hazard ratio = 1.04, 95% confidence interval = 1.02-1.05, P < 0.0001). Age, sex, FLI, cigarette smoking, and diabetes were independently associated with all-cause mortality. Age, sex, FLI, systolic blood pressure, and fibrinogen were independently associated with CVD mortality; meanwhile, age, sex, FLI, and smoking were independently associated with cancer mortality. FLI correlated with the homeostasis model assessment of insulin resistance (HOMA-IR), a surrogate marker of insulin resistance (Spearman's ρ = 0.57, P < 0.0001), and when HOMA-IR was included in the multivariate analyses, FLI retained its association with hepatic-related mortality but not with all-cause, CVD, and cancer-related mortality. Conclusion: FLI is independently associated with hepatic-related mortality. It is also associated with all-cause, CVD, and cancer mortality rates, but these associations appear to be tightly interconnected with the risk conferred by the correlated insulin-resistant state. © 2011 American Association for the Study of Liver Diseases.

Trape J.,Laboratory Medicine Service | Montesinos J.,Medical Oncology Service | Catot S.,Medical Oncology Service | Buxo J.,Medical Oncology Service | And 6 more authors.
International Journal of Biological Markers | Year: 2012

Aims: The objective of the present study is to determine the prognostic value of clinical variables and biomarkers in patients with advanced stages of NSCLC and establish a prognostic classification of these patients. Methods: For 135 patients with advanced NSCLC we determined their clinical variables and their levels of CEA, CA 125, CYFRA 21-1, albumin, LDH, erythrosedimentation and leukocytes. Results: Multivariate analysis identified PS (ECOG) >1, metastases, no anti-neoplastic treatment, CA 125 >35 U/mL, CYFRA 21-1 >3.3 ng/mL and leukocytes >10'000/μL, as independent prognostic factors for survival. Patients were classified into 3 groups according to the number of adverse prognostic factors (APF). One point was assigned for each APF, except for chemotherapy treatment. Patients with 0-1 APF represented our reference group: patients with 2-3 APF had HR=2.7 (95% CI: 1.5-4.6), while patients with 4-5 APF had HR=8.8 (95% CI: 4.6-16.8). This "score" maintained the differences between risk groups both in patients who received antineoplastic treatment and in those who did not. Conclusion: The application of a score that includes clinical data and biomarkers may improve the prognostic classification of NSCLC patients. © 2012 Wichtig Editore.

Valdivia A.,Preventive Medicine Unit | Lopez-Alcalde J.,Health Technology Asessment Unit | Vicente M.,Primary Health Care | Pichiule M.,Hospital Universitario Of La Princesa | And 2 more authors.
Eurosurveillance | Year: 2010

The number of Internet searches has recently been used by Google to estimate the influenza incidence in the United States. We examined the correlation between the Google Flu Trends tool and sentinel networks estimates in several European countries during the 2009 influenza A(H 1N 1) pandemic and found a good correlation between estimates and peak incidence timing, with the highest peaks in countries where Internet is most frequently used for health-related searching. Although somehow limited, Google could be a valuable tool for syndromic surveillance.

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