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San Juan de Alicante, Spain

Esquerdo G.,Clinica Benidorm | Domenech M.,Fundacio Althaia | Lopez P.,Hospital General Virgen de Las Nieves | Pedro C.,Hospital Del Mar | And 27 more authors.

Aims and background. The present study aims to describe the hematological response to darbepoetin alfa (DA) under daily clinical practice conditions in anemic elderly patients with non-myeloid tumors receiving chemotherapy. Methods and study design. This was a prospective, observational, multicenter study in elderly (≥65 years) patients with non-myeloid cancer receiving DA (500 g every 3 weeks) for chemotherapy-induced anemia (hemoglobin [Hb] level ≤11.0 g/dL). Results. A total of 102 anemic patients with solid tumors and 51 with hematological malignancies were included in 28 centers in Spain. Mean age (±SD) was 73.4 (±5.8) years, and mean baseline Hb level was 10.0 (±0.8) g/dL. DA was administered for a median of 8 weeks. Of the 115 subjects with a post-baseline Hb value, the percentage of patients who achieved a hematopoietic response (Hb increase ≥2 g/dL or reaching ≥12 g/dL without transfusions in the previous 28 days) was 69.7% (95% CI 56.1% to 83.3%). Functional Assessment of Cancer Therapy-Fatigue subscale scores increased during the study (median change 1.0 [Q1 -5.0, Q3 9.0], P = 0.04). One patient (0.7%) experienced a non-serious adverse reaction (cutaneous rash). Conclusion. The study results suggest that DA is an effective and well-tolerated therapy for the treatment of chemotherapy-induced anemia in elderly patients. Copyright - Il Pensiero Scientifico Editore. Source

Bustos A.,Clnica Vistahermosa | Alvarez R.,Hospital Virgen de la Salud | Aramburo P.M.,Hospital Rber Internacional | Carabantes F.,Hospital Carlos Haya | And 6 more authors.
Current Medical Research and Opinion

Purpose: To investigate the patterns of use of darbepoetin alfa in Spanish centers, and to evaluate its effectiveness in the treatment of chemotherapy-induced anemia under clinical practice conditions. Methods: This was an observational, retrospective, multicenter study in adult patients with non-myeloid malignancies who initiated chemotherapy and darbepoetin alfa. Data was collected for up to 16 weeks or until treatment discontinuation. Results: A total of 685 patients (72.7% with solid tumors and 27.3% with hematologic malignancies) were included in the study. Median age was 64.7 years (range 18.588.9 years), 50.7% were women, 82.4% had ECOG status 01 and 80.5% had stage III/IV cancer. At darbepoetin initiation, mean hemoglobin (Hb) was 100g/L (SD 10), with 11.0% and 23.1% of patients below 90g/L in solid and hematologic malignancies, respectively. A decrease in transfusion requirements was observed between weeks 516 with respect to weeks 016 (13.3% [95% CI: 10.7 to 15.9] versus 19.0% [95% CI: 16.0 to 22.0]). Hb levels were significantly increased during the treatment (mean change of 10.4g/L for solid tumors [p<0.001], and 16.6g/L for hematologic malignancies [p<0.001]). The percentage of patients with baseline Hb level <110g/L who achieved an Hb level ≥110g/L during the study was 66.5% (95% CI: 62.5% to 70.5%). Six serious adverse reactions were considered related to darbepoetin alfa (thromboembolic events, 1.0%). Conclusions: With the limitation of a retrospective design, our results suggest that darbepoetin alfa is a well tolerated treatment that increases hemoglobin levels and reduces the need for transfusion in cancer patients receiving chemotherapy in clinical practice. © 2012 Informa UK Ltd. Source

Miro O.,Area de Urgencias | Escoda R.,Area de Urgencias | Martin-Sanchez F.J.,Servicio de Urgencias | Herrero P.,Hospital Universitario Central Of Asturias | And 27 more authors.

Objectives. To determine perception of quality of care for acute heart failure (AHF) of patients discharged from the emergency department in comparison with the perception of admitted patients; to explore the variables associated with perception of quality. Methods. Prospective, cross-sectional case–control study in 7 emergency departments. Consecutive patients diagnosed with AHF were recruited to answer a telephone survey assessing their view of quality of physician care, nurse care, overall treatment, and degree of resolution of their problem in the emergency department. Discharged patients were also asked to state their level of agreement with the decision to send them home from the emergency department. The answers of patients who were discharged home were compared with patients who were admitted to the ward. The results were analyzed according to whether or not adverse events occurred within 30 days. Results. A total of 1147 patients were enrolled and 1003 (87.4%) were interviewed; 253 of the patients (25.2%) were discharged home. We found no significant differences in any of the assessments (on physician or nurse care, overall treatment, or degree of resolution) between patients who were discharged home and those who were admitted. The mean (SD) overall satisfaction assessments (on a scale of 0 to 10) were 7.34 (1.38) and 7.38 (1.52), respectively, in the 2 groups (P=.66). Over 90% of those discharged home agreed with or strongly agreed with the decision. Evaluations were unrelated to whether or not adverse events occurred in the next 30 dyas. Conclusions. Patients with AHF have high opinions of the different components of care received in the emergency department, and their evaluations are unrelated to whether they were admitted or discharged home. Those discharged home agree with the decision and their opinion remains firm regardless of whether adverse events occur later. © 2015 Grupo Saned. All rights reserved. Source

De La Torre Hernndez J.M.,Unidad University | Alfonso F.,Hospital Clnico San Carlos | Gimeno F.,Hospital Clinico de Valladolid | Diarte J.A.,Hospital Miguel Servet | And 19 more authors.
JACC: Cardiovascular Interventions

Objectives This study sought to evaluate second-generation drug-eluting stent (DES) thrombosis in clinical practice. Background First-generation DES are associated with a significant incidence of late thrombosis. There is paucity of data regarding real practice late thrombosis incidence and predictors with second-generation DES, zotarolimus-eluting stent (ZES), and everolimus-eluting stents (EES). Methods A prospective, large-scale, non-industry-linked multicenter registry was designed. Complete clinical-procedural data and systematic follow-up of all patients treated with these stents was reported in a dedicated registry supported by the Spanish Working Group on Interventional Cardiology. Results From 2005 to 2008, 4,768 patients were included in 34 centers: 2,549 treated with ZES, and 2,219 with EES. The cumulative incidence of definite/probable thrombosis for ZES was 1.3% at 1 year and 1.7% at 2 years and for EES 1.4% at 1 year and 1.7% at 2 years (p = 0.8). The increment of definite thrombosis between the first and second year was 0.2% and 0.25%, respectively. In a propensity score analysis, the incidence remained very similar. Ejection fraction (adjusted hazard ratio [HR]: 0.97; 95% confidence interval [CI]: 0.95 to -0.99; p = 0.008), stent diameter (adjusted HR: 0.37; 95% CI: 0.17to 0.81; p = 0.01) and bifurcations (adjusted HR: 2.1; 95% CI: 1.14 to 3.7; p = 0.02) emerged as independent predictors of thrombosis. In the subgroup of patients with bifurcations, the use of ZES was independently associated with a higher thrombosis rate (adjusted HR: 4; 95% CI: 1.1 to 13; p = 0.03). Conclusions In a real practice setting, the incidence of thrombosis at 2 years with ZES and EES was low and quite similar. The incidence of very late thrombosis resulted lower than was reported in registries of first-generation DES. In the subset of bifurcations, the use of ZES significantly increased the risk of thrombosis. © 2010 American College of Cardiology Foundation. Source

Darba J.,University of Barcelona | Restovic G.,Health Economics and Outcomes Research | Kaskens L.,Health Economics and Outcomes Research | Balbona M.A.,Hospital Universitario La Paz | And 6 more authors.
Osteoporosis International

Summary: In Spain, various treatments are available to prevent osteoporotic fractures. A discrete choice experiment (DCE) was used to investigate the importance of different treatment aspects and its influence on patients' preferences. All attributes included as type and place of drug administration as well as costs showed to be significant predictors of choice. Spanish osteoporosis patients have well-defined preferences and accept trade-offs among attributes. Introduction This study was designed to identify patient preferences for different aspects of osteoporosis treatments in Spain. Methods Main attributes of severe osteoporosis treatments were determined by literature review and consultations with nurses. The discrete choice experiment included three attributes: type of drug administration, place of administration, plus a cost attribute in order to estimate willingness to pay for improvements in attribute levels. A pilot study with 50 patients was performed to identify the areas of misunderstanding. One hundred sixty-six patients with a diagnosis of osteoporosis and severe osteoporosis were presented with pairs of hypothetical treatment profiles with different type of administration levels, places of administration and costs. Questions to collect socio-demographic and disease-related treatment data were also included. Data were analysed using a random effects probit model. Results All attributes had the expected polarity and were significant predictors of choice. Patients were willing to pay 183 €/month to have a subcutaneous injection once per day rather than an intravenous injection once per year. Patients with osteoporosis were willing to pay 121 €/month to have medical support when administering the drug treatment at home rather than being admitted several hours to a hospital for drug administration. Conclusion Spanish osteoporosis patients have well-defined preferences among treatment attributes and are willing to accept trade-offs among attributes. Participants indicated that they are willing to accept self medication with medical support rather than being hospitalised for several hours. The perspective of the patients should be taken into account when making treatment decisions. © International Osteoporosis Foundation and National Osteoporosis Foundation 2010. Source

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