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Escuriet R.,University Pompeu Fabra | Pueyo M.,Directorate General for Health Planning and Research | Biescas H.,Directorate General for Health Planning and Research | Colls C.,Catalan Agency for Health Information | And 6 more authors.
BMC Pregnancy and Childbirth | Year: 2014

Background: Childbirth assistance in highly technological settings and existing variability in the interventions performed are cause for concern. In recent years, numerous recommendations have been made concerning the importance of the physiological process during birth. In Spain and Catalonia, work has been carried out to implement evidence-based practices for childbirth and to reduce unnecessary interventions. To identify obstetric intervention rates among all births, determine whether there are differences in interventions among full-term single births taking place in different hospitals according to type of funding and volume of births attended to, and to ascertain whether there is an association between caesarean section or instrumental birth rates and type of funding, the volume of births attended to and women's age. Methods: Cross-sectional study, taking the hospital as the unit of analysis, obstetric interventions as dependent variables, and type of funding, volume of births attended to and maternal age as explanatory variables. The analysis was performed in three phases considering all births reported in the MBDS Catalonia 2011 (7,8570 births), full-term single births and births coded as normal. Results: The overall caesarean section rate in Catalonia is 27.55% (CI 27.23 to 27.86). There is a significant difference in caesarean section rates between public and private hospitals in all strata. Both public and private hospitals with a lower volume of births have higher obstetric intervention rates than other hospitals (49.43%, CI 48.04 to 50.81). Conclusions: In hospitals in Catalonia, both the type of funding and volume of births attended to have a significant effect on the incidence of caesarean section, and type of funding is associated with the use of instruments during delivery. © 2014 Escuriet et al.; licensee BioMed Central Ltd. Source


Gonzalez-Porras J.R.,Ibsal Hospital Universitario Of Salamanca | Mingot-Castellano M.E.,Hospital Regional Universitario Of Malaga | Andrade M.M.,Hospital Universitario Miguel Servet | Alonso R.,Hospital Universitario Doce Of Octubre | And 19 more authors.
British Journal of Haematology | Year: 2015

The thrombopoietin receptor agonists (THPO-RAs), romiplostim and eltrombopag, are effective and safe in immune thrombocytopenia (ITP). However, the value of their sequential use when no response is achieved or when adverse events occur with one THPO-RA has not been clearly established. Here we retrospectively evaluated 51 primary ITP adult patients treated with romiplostim followed by eltrombopag. The median age of our cohort was 49 (range, 18-83) years. There were 32 women and 19 men. The median duration of romiplostim use before switching to eltrombopag was 12 (interquartile range 5-21) months. The reasons for switching were: lack of efficacy (n = 25), patient preference (n = 16), platelet-count fluctuation (n = 6) and side-effects (n = 4). The response rate to eltrombopag was 80% (41/51), including 67% (n = 35) complete responses. After a median follow-up of 14 months, 31 patients maintained their response. Efficacy was maintained after switching in all patients in the patient preference, platelet-count fluctuation and side-effect groups. 33% of patients experienced one or more adverse events during treatment with eltrombopag. We consider the use of eltrombopag after romiplostim for treating ITP to be effective and safe. Response to eltrombopag was related to the cause of romiplostim discontinuation. © 2014 John Wiley & Sons Ltd. Source


Gonzalez-Lopez T.J.,Hospital Universitario Of Burgos | Pascual C.,Hospital General Universitario Gregorio Maranon | Alvarez-Roman M.T.,Hospital Universitario La Paz | Fernandez-Fuertes F.,Hospital Universitario Insular Of Gran Canaria | And 44 more authors.
American Journal of Hematology | Year: 2015

Eltrombopag is effective and safe in immune thrombocytopenia (ITP). Some patients may sustain their platelet response when treatment is withdrawn but the frequency of this phenomenon is unknown. We retrospectively evaluated 260 adult primary ITP patients (165 women and 95 men; median age, 62 years) treated with eltrombopag after a median time from diagnosis of 24 months. Among the 201 patients who achieved a complete remission (platelet count >100 × 109/l), eltrombopag was discontinued in 80 patients. Reasons for eltrombopag discontinuation were: persistent response despite a reduction in dose over time (n = 33), platelet count >400 × 109/l (n = 29), patient's request (n = 5), elevated aspartate aminotransferase (n = 3), diarrhea (n = 3), thrombosis (n = 3), and other reasons (n = 4). Of the 49 evaluable patients, 26 patients showed sustained response after discontinuing eltrombopag without additional ITP therapy, with a median follow-up of 9 (range, 6-25) months. These patients were characterized by a median time since ITP diagnosis of 46.5 months, with 4/26 having ITP<1 year. Eleven patients were male and their median age was 59 years. They received a median of 4 previous treatment lines and 42% were splenectomized. No predictive factors of sustained response after eltrombopag withdrawal were identified. Platelet response following eltrombopag cessation may be sustained in an important percentage of adult primary ITP patients who achieved CR with eltrombopag. However, reliable markers for predicting which patients will have this response are needed. © 2014 Wiley Periodicals, Inc. Source


Fondevilla E.,at Coordinating Center | Grau S.,Autonomous University of Barcelona | Mojal S.,Consulting Service on Methodology for Biomedical Research | Palomar M.,Hospital Arnau de Vilanova | And 66 more authors.
Expert Review of Anti-Infective Therapy | Year: 2016

Objective To know the patterns and consumption trends (2008-2013) of antifungal agents for systemic use in 52 acute care hospitals affiliated to VINCat Program in Catalonia (Spain). Methods Consumption was calculated in defined daily doses (DDD)/100 patient-days and analyzed according to hospital size and complexity and clinical departments. Results Antifungal consumption was higher in intensive care units (ICU) (14.79) than in medical (3.08) and surgical departments (1.19). Fluconazole was the most consumed agent in all type of hospitals and departments. Overall antifungal consumption increased by 20.5%during the study period (p = 0.066); a significant upward trend was observed in the consumption of both azoles and echinocandins. In ICUs, antifungal consumption increased by 12.4% (p = 0.019). Conclusions The study showed a sustained increase in the overall consumption of systemic antifungals in a large number of acute care hospitals of different characteristics in Catalonia. In ICUs there was a trend towards the substitution of older agents by the new ones. © 2015 Taylor & Francis. Source


Grant
Agency: Cordis | Branch: H2020 | Program: RIA | Phase: PHC-19-2014 | Award Amount: 3.81M | Year: 2015

Demographic and epidemiologic transitions have brought a new health care paradigm with the presence of both, growing elderly population and chronic diseases. Life expectancy is increasing as well as the need for long-term care. Institutional care for the aged population faces economical struggles with low staffing ratios and consequent quality problems. Although the aforementioned implications of ageing impose societal challenges, at the same time new opportunities arise for the European citizens, the healthcare systems as well as the industry and the European market. Two of the most important aspects of assistive environments and independent living are user acceptance and unobtrusiveness. Mostly explored in a smart home setup and the unobtrusive installation of audio-visual monitoring equipment, the consensus is that users accept monitoring if they are not constantly aware of its presence. A more recent trend is home assistant robots. These two lines of development have for the most part ran without heavily interacting with each other and, even more so, without developing integrated solutions that combine smart home automation with robotics. In RADIO, we will develop an integrated smart home/assistant robot system, with the objective of pursuing a novel approach to acceptance and unobtrusiveness: a system where sensing equipment is not discrete but an obvious and accepted part of the users daily life. By using the integrated smart home/assistant robot system as the sensing equipment for health monitoring, we mask the functionality of the sensors rather than the sensors themselves. In this manner, sensors do not need to be discrete and distant or masked and cumbersome to install; they do however need to be perceived as a natural component of the smart home/assistant robot functionalities.

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