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Dagenais G.R.,University of Quebec | Lu J.,University of Pittsburgh | Faxon D.P.,Harvard University | Bogaty P.,University of Quebec | And 6 more authors.
Journal of the American College of Cardiology

Objectives: The purpose of this analysis was to assess in patients with type 2 diabetes and stable coronary artery disease (CAD) whether the risk of all-cause mortality and cardiovascular events varied according to the presence or absence of angina and angina equivalent symptoms. Background: Data on the prognostic value of symptoms in these patients are limited. Methods: Post-hoc analysis was performed in 2,364 patients with type 2 diabetes and documented CAD enrolled in the BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial to determine the occurrence of death and composite of death, myocardial infarction, and stroke during a 5-year follow-up according to cardiac symptoms at baseline. Results: There were 1,434 patients with angina (A), 506 with angina equivalents (E), and 424 with neither of these (N). The cumulative death rates (total 316) were 12% in A, 14% in E, and 10% in N (p = 0.3), and cardiovascular composite rates (total 548) were 24% in A, 24% in E, and 21% in N (p = 0.5). Compared with N, the hazard ratios adjusted for confounders were not different for death in A (1.11; 99% CI: 0.81 to 1.53) and E (1.17; 99% CI: 0.81 to 1.68) or for cardiovascular events in A (1.17; 99% CI: 0.92 to 1.50) and E (1.11; 99% CI: 0.84 to 1.48). Conclusions: Whatever their symptom status, patients with type 2 diabetes and stable CAD were at similar risk of cardiovascular events and death. These findings suggest that these patients may be similarly managed in terms of risk stratification and preventive therapies. (Bypass Angioplasty Revascularization Investigation 2 Diabetes [BARI 2D]; NCT00006305) © 2013 American College of Cardiology Foundation. Source

Doubova S.V.,Mexican Institute of Social Security | Lamadrid-Figueroa H.,National Health Research Institute | Perez-Cuevas R.,Inter American Development Bank
Journal of Hypertension

OBJECTIVES: Patients with hypertension require life-long care and should be monitored to identify whether they are receiving the appropriate healthcare and reach their expected health outcomes. Our objectives were to develop quality of healthcare indicators (QCI) and evaluate the quality of care that hypertensive patients receive in family medicine clinics at the Mexican Institute of Social Security. METHOD: We used a two-stage mixed methods approach: development of QCIs following the RAND-UCLA method; quality of care evaluation using electronic health record (EHR) data from 47150 hypertensive patients who received care in 2009. We developed 15 QCIs, which were possible to construct using EHR data. The QCIs evaluated the process of care and health outcomes. RESULTS: Most hypertensive patients were women (64%) more than 60 years old; 79% were overweight/obese and 31% had diabetes. On average, these patients attended regularly to the family doctor (≥7 visits a year); however, they received only 27% of recommended care. Among the hypertensive patients without comorbidity, 62% had achieved blood pressure (BP) control, whereas in the group of hypertensive patients with diabetes or chronic kidney disease, only 7% had achieved BP control. CONCLUSION: EHR can become a source of information to evaluate routinely quality of care in developing countries that are beginning to modernize their health information systems. © 2013 Wolters Kluwer Health / Lippincott Williams & Wilkins. Source

Doubova S.V.,Mexican Institute of Social Security
International Journal for Quality in Health Care

Objective: (i) To develop quality-of-care indicators suitable for evaluation of care for knee and hip osteoarthritis (KHOA) at the primary care level using data from the electronic health records (EHRs) and (ii) to evaluate the quality of care that patients with KHOA receive at family medicine clinics (FMCs). Design: (i) Development of indicators following the RAND-UCLA method. (ii) A cross-sectional analysis of quality-of-care provided for patients with osteoarthritis. Setting: Four FMCs in Mexico City. Participants: Knee and hip osteoarthritis patients, older than 19 years. Source of the Information: 2009 EHR data. Main Outcome Measure(s): Quality of care was evaluated using six indicators developed in the first stage of this study. Results: The quality of care evaluation identified that 26.1% of patients were advised in regard to physical exercise, and weight loss was encouraged in 19.7%. Only 5% of patients received acetaminophen as an initial oral analgesic; 54% of patients at risk for gastrointestinal complications received gastroprotective medicines. On average, the percentage of recommended care received was lower for patients who attended only one visit with family physician (17.6%) and higher for those with >3 visits (41.9%). Conclusion: The quality of osteoarthritis care at FMCs in Mexico is suboptimal relative to the standards of care and requires continuous evaluation and implementation of improvement strategies. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved. Source

Juarez-Cedillo T.,Mexican Institute of Social Security
Genetics and molecular research : GMR

We evaluated the cost-effectiveness of using buccal swab brushes in comparison with blood samples for obtaining DNA for large epidemiological studies of the elderly population. The data reported here are from the third phase of the Integral Study of Depression among the Elderly in Mexico City's Mexican Institute of Social Security, conducted in 2007. The total cost of the two procedures was determined. The measurement of effectiveness was the quality and quantity of DNA measured in ng/μL and the use of this DNA for the determination of apolipoprotein E (APO E) polymorphism by PCR. Similar rates of amplification were obtained with the two techniques. The cost of the buccal swab brushes, including sample collection and DNA extraction, was US$16.63, compared to the cost per blood sample of US$23.35. Using the buccal swab, the savings was US$6.72 per patient (P < 0.05). The effectiveness was similar. Quantity and quality of DNA obtained were similar for the oral and blood procedures, demonstrating that the swab brush technique offers a feasible alternative for large-scale epidemiological studies. Source

Escalante M.,Mexican Institute of Social Security | Gagliardino J.J.,CONICET | Guzman J.R.,Latin University | Tschiedel B.,Institute for Children with Diabetes in Porto Alegre and the Brazilian Diabetes Society
Diabetes Research and Clinical Practice

Latin America faces a unique set of challenges in the treatment of type 2 diabetes mellitus (T2DM). This report identifies these challenges and provides a framework for implementation of the strategies, policies and education programs which are needed to optimize the management of this condition. In order to improve future diabetes care, it will be necessary to address existing problems such as limitation of resources, inadequate management of hyperglycemia, and inappropriate education of healthcare team members and people with diabetes. Achieving these goals will require collaborative efforts by many individuals, groups and organizations. These include policymakers, international organizations, healthcare providers, those responsible for setting medical school curricula, patients and society as a whole. It is anticipated that improved/continuing education of healthcare professionals, diabetes self-management education and development of a team approach for T2DM care will lead to optimization of patient-centered care. Implementation of multicentric demonstration studies and rational use of antidiabetic treatments will be necessary to demonstrate the long-term favorable impact of these strategies upon quality of care, prevention of chronic complications, mortality, healthcare costs and patient quality of life. © 2014 Elsevier Ireland Ltd. Source

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