Sociedad Espanola de Medicina de Familia y Comunitaria

Villanueva del Río y Minas, Spain

Sociedad Espanola de Medicina de Familia y Comunitaria

Villanueva del Río y Minas, Spain
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Lobos Bejarano J.M.,Comite Espanol Interdisciplinario de Prevencion Cardiovascular | Galve E.,Seccion de Riesgo Vascular y Rehabilitacion Cardiaca | Royo-Bordonada M.A.,Comite Espanol Interdisciplinario de Prevencion Cardiovascular | Royo-Bordonada M.A.,Institute Salud Carlos III | And 11 more authors.
Revista Espanola de Cardiologia | Year: 2014

The publication of the 2013 American College of Cardiology/American Heart Association guidelines on the treatment of high blood cholesterol has had a strong impact due to the paradigm shift in its recommendations. The Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology reviewed this guideline and compared it with current European guidelines on cardiovascular prevention and dyslipidemia management. The most striking aspect of the American guideline is the elimination of the low-density lipoprotein cholesterol treat-to-target strategy and the adoption of a risk reduction strategy in 4 major statin benefit groups. In patients with established cardiovascular disease, both guidelines recommend a similar therapeutic strategy (high-dose potent statins). However, in primary prevention, the application of the American guidelines would substantially increase the number of persons, particularly older people, receiving statin therapy. The elimination of the cholesterol treat-to-target strategy, so strongly rooted in the scientific community, could have a negative impact on clinical practice, create a certain amount of confusion and uncertainty among professionals, and decrease follow-up and patient adherence. Thus, this article reaffirms the recommendations of the European guidelines. Although both guidelines have positive aspects, doubt remains regarding the concerns outlined above. In addition to using risk charts based on the native population, the messages of the European guideline are more appropriate to the Spanish setting and avoid the possible risk of overtreatment with statins in primary prevention. Full English text available from: www.revespcardiol.org/en © 2014 Sociedad Española de Cardiología.


Perez Perez A.,Sociedad Espanola de Diabetes | Gomez Huelgas R.,Sociedad Espanola de Medicina Interna | Alvarez Guisasola F.,Sociedad Espanola de Medicina de Familia y Comunitaria | Garcia Alegria J.,Sociedad Espanola de Medicina Interna | And 2 more authors.
Medicina Clinica | Year: 2012

The present document intends to adapt the general recommendations set up in a consensus to elaborate the hospital discharge report in medical specialties to the specific needs of the hospitalized diabetic population. Diabetes is an illness with a very high health cost, being the global risk of death in people with diabetes almost double than in non-diabetes people, justifying the fact that diabetes constitutes one of the most frequent diagnoses in hospitalized patients and the growing interest upon hyperglycaemia management during hospitalization and at discharge. To set up an adequate treatment plan at discharge suitable for each patient, the most important elements to take into account are the etiology and prior hyperglycaemia treatment, the patient's clinical situation and the degree of glycaemia control. Due to instability of glycaemia control, it is also needed to anticipate the educational needs for each patient, as well as to set up the monitoring schedule and follow-up at discharge, and an adequate treatment plan at discharge. © 2011 Elsevier España, S.L. All rights reserved.


Royo-Bordonada M.A.,Institute Salud Carlos III | Lobos J.M.,Sociedad Espanola de Medicina de Familia y Comunitaria | Brotons C.,Sociedad Espanola de Medicina de Familia y Comunitaria | Villar F.,Sociedad Espanola de Arteriosclerosis | And 7 more authors.
Medicina Clinica | Year: 2014

Background and objective: In Spain, where cardiovascular diseases are the leading cause of death, control of their risk factors is low. This study analyzes the implementation of cardiovascular risk (CVR) assessment in clinical practice and the existence of control objectives amongst quality care indicators and professional incentive systems. Method: Between 2010 and 2011, data from each autonomous community were collected, by means of a specific questionnaire concerning prevalence and control of major CVR factors, CVR assessment, and implementation of control objectives amongst quality care indicators and primary care incentive systems. Results: Fifteen out of 17 autonomous communities filled in the questionnaire. CVR was calculated through SCORE in 9 autonomous communities, REGICOR in 3 and Framingham in 3, covering 3.4 to 77.6% of target population. The resulting control of the main CVR factors was low and variable: hypertension (22.7-61.3%), dyslipidemia (11-45.1%), diabetes (18.5-84%) and smoking (20-50.5%). Most autonomous communities did not consider CVR assessment and control amongst quality care indicators or incentive systems, highlighting the lack of initiatives on lifestyles. Conclusions: Variability exists in cardiovascular prevention policies among autonomous communities. It is necessary to implement a common agreed cardiovascular prevention guide, to encourage physicians to implement CVR in electronic clinical history, and to promote CVR assessment and control inclusion amongst quality care indicators and professional incentive systems, focusing on lifestyles management. © 2012 Elsevier España, S.L. All rights reserved.


Grant
Agency: European Commission | Branch: FP7 | Program: CP-IP | Phase: HEALTH.2011.2.3.1-3 | Award Amount: 15.65M | Year: 2011

Antibiotics are a mainstay of public health, but their use has increased exponentially leading to the emergence of antibiotic resistance. The R-GNOSIS (Resistance in Gram-Negative Organisms: Studying Intervention Strategies) project combines 5 international clinical studies, all supported by highly innovative microbiology, mathematical modelling and data-management, to determine - in the most relevant patient populations - the efficacy and effectiveness of cutting-edge interventions to reduce carriage, infection and spread of Multi-Drug Resistant Gram-negative Bacteria (MDR-GNB). All work-packages will progress science beyond the state-of-the-art in generating new and translational clinically relevant knowledge, through hypothesis-driven studies focussed on patient-centred outcomes. The 5 clinical studies will investigate the following interventions: A Point-Of-Care-Testing guided management strategy to improve appropriate antibiotic prescription for uncomplicated UTI in primary care. Gut decolonization in outpatients with intestinal carriage of MDR-GNB. A test and prescribe strategy, based on rapid diagnostic testing of faeces for MDR-GNB to optimize antibiotic prophylaxis in colo-rectal surgery. Contact Isolation of patients with ESBL-producing Enterobacteriaceae in general hospital wards. Three Decolonization strategies in ICUs. Seven laboratories across Europe will perform microbiological analyses, as well as unique quantitative experiments. All information will be integrated by 3 groups of mathematical modellers into highly innovative models to better understand and predict future trends and effects of interventions. The studies and analyses proposed in R-GNOSIS will generate a step-change in identifying evidence-based preventive measures and clinical guidance for primary care and hospital-based physicians and health-care authorities, to combat the spread and impact of infections caused by MDR-GNB in Europe.


Grant
Agency: European Commission | Branch: H2020 | Program: RIA | Phase: ICT-22-2014 | Award Amount: 3.63M | Year: 2015

In Europe, migration is tradition and not only since the European legislation changed towards free migration of European citizens. This is not free of challenges. Especially in the case of care, migrants, often face a double challenge: (i) not to speak the language and not to be acquainted with the culture of the resident country, and (ii) be unfamiliar with the care and health administrations of the country. As a consequence, e.g., elderly migrants in care homes suffer from social exclusion, with their relatives also struggling with getting the right information and interacting with the administration, migrants at home are often reluctant to go to see the doctor in case of health issues, a tendency that is often further aggravated by cultural matters. Migrant temporary care workers, who in addition often do not have an adequate professional training, face the problem of isolation, lack of professional background information and deficient communication with both the cared and the supervision personnel. KRISTINAs overall objective is to research and develop technologies for a human-like socially competent and communicative agent that is run on mobile communication devices and that serves for migrants with language and cultural barriers in the host country as a trusted information provision party and mediator in questions related to basic care and healthcare. To develop such an agent, KRISTINA will advance the state of the art in dialogue management, multimodal (vocal, facial and gestural) communication analysis and multimodal communication. The technologies will be validated in two use cases, in which prolonged trials will be carried out for each prototype that marks the termination of a SW development cycle, with a representative number of migrants recruited as users from the migration circles identified as especially in need: elderly Turkish migrants and their relatives and short term Polish care giving personnel in Germany and North African migrants in Spain.


PubMed | Sociedad Espanola de Cardiologia, Institute Salud Carlos III, Seccion de Riesgo Vascular y Rehabilitacion Cardiaca, Comite Espanol Interdisciplinario de Prevencion Cardiovascular and 2 more.
Type: Journal Article | Journal: Revista espanola de cardiologia (English ed.) | Year: 2014

The publication of the 2013 American College of Cardiology/American Heart Association guidelines on the treatment of high blood cholesterol has had a strong impact due to the paradigm shift in its recommendations. The Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology reviewed this guideline and compared it with current European guidelines on cardiovascular prevention and dyslipidemia management. The most striking aspect of the American guideline is the elimination of the low-density lipoprotein cholesterol treat-to-target strategy and the adoption of a risk reduction strategy in 4 major statin benefit groups. In patients with established cardiovascular disease, both guidelines recommend a similar therapeutic strategy (high-dose potent statins). However, in primary prevention, the application of the American guidelines would substantially increase the number of persons, particularly older people, receiving statin therapy. The elimination of the cholesterol treat-to-target strategy, so strongly rooted in the scientific community, could have a negative impact on clinical practice, create a certain amount of confusion and uncertainty among professionals, and decrease follow-up and patient adherence. Thus, this article reaffirms the recommendations of the European guidelines. Although both guidelines have positive aspects, doubt remains regarding the concerns outlined above. In addition to using risk charts based on the native population, the messages of the European guideline are more appropriate to the Spanish setting and avoid the possible risk of overtreatment with statins in primary prevention.


PubMed | Sociedad Espanola de Epidemiologia., Federacion de Asociaciones de Enfermeria Comunitaria y Atencion Primaria., Sociedad Espanola de Arteriosclerosis., Ministerio de Sanidad and 12 more.
Type: | Journal: Hipertension y riesgo vascular | Year: 2016

The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines dont recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.


PubMed | Sociedad Espanola de Medicina Interna, Sociedad Espanola de Medicina de Familia y Comunitaria, Sociedad Espanola de Cardiologia, Sociedad Espanola de Medicos de Atencion Primaria and Sociedad Espanola de Medicos Generales y de Familia
Type: | Journal: Medicina clinica | Year: 2016

Cardiovascular disease is a chronic disorder which is usually already at an advanced stage when the first symptoms develop. The fact that the initial clinical presentation can be lethal or highly incapacitating emphasizes the need for primary and secondary prevention. It is estimated that the ratio of patients with good adherence to secondary prevention of cardiovascular disease is low and also decreases gradually over time. The Polypill for secondary prevention of cardiovascular disease is the first fixed-dose combination therapy of salicylic acid, atorvastatin and ramipril approved in Spain. The purpose of this consensus document was to define and recommend, through the evidence available in the literature and clinical expert opinion, the impact of treatment adherence in the secondary prevention of cardiovascular disease and the use of the Polypill in daily clinical practice as part of a global strategy including adjustments in patient lifestyle. A RAND/UCLA methodology based on scientific evidence, as well as the collective judgment and clinical expertise of an expert panel was used for this assessment. As a result, a final report of recommendations on the impact of the lack of adherence to treatment of secondary prevention of cardiovascular disease and the effect of using a Polypill in adherence of patients was produced. The recommendations included in this document have been addressed to all those specialists, cardiologists, internists and primary care physicians with competence in prescribing and monitoring patients with high and very high cardiovascular risks.


PubMed | Sociedad Espanola de Epidemiologia., Federacion de Asociaciones de Enfermeria Comunitaria y Atencion Primaria., Sociedad Espanola de Arteriosclerosis., Ministerio de Sanidad and 12 more.
Type: | Journal: Revista espanola de salud publica | Year: 2016

The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than 10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines dont recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.


PubMed | Federacion de Asociaciones de Enfermeria Comunitaria y Atencion Primaria, Sociedad Espanola de Cardiologia, Institute Salud Carlos III, Sociedad Espanola de Hipertension Liga Espanola de la Lucha Contra la Hipertension Arterial and 6 more.
Type: Journal Article | Journal: Medicina clinica | Year: 2013

In Spain, where cardiovascular diseases are the leading cause of death, control of their risk factors is low. This study analyzes the implementation of cardiovascular risk (CVR) assessment in clinical practice and the existence of control objectives amongst quality care indicators and professional incentive systems.Between 2010 and 2011, data from each autonomous community were collected, by means of a specific questionnaire concerning prevalence and control of major CVR factors, CVR assessment, and implementation of control objectives amongst quality care indicators and primary care incentive systems.Fifteen out of 17 autonomous communities filled in the questionnaire. CVR was calculated through SCORE in 9 autonomous communities, REGICOR in 3 and Framingham in 3, covering 3.4 to 77.6% of target population. The resulting control of the main CVR factors was low and variable: hypertension (22.7-61.3%), dyslipidemia (11-45.1%), diabetes (18.5-84%) and smoking (20-50.5%). Most autonomous communities did not consider CVR assessment and control amongst quality care indicators or incentive systems, highlighting the lack of initiatives on lifestyles.Variability exists in cardiovascular prevention policies among autonomous communities. It is necessary to implement a common agreed cardiovascular prevention guide, to encourage physicians to implement CVR in electronic clinical history, and to promote CVR assessment and control inclusion amongst quality care indicators and professional incentive systems, focusing on lifestyles management.

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