1
|
Márquez Mesa E, Suárez Llanos JP, Afonso Martín PM, Negrín CB, García Ascanio M, González González S, Llorente Gómez de Segura I. Influence of the Results of Control of Intakes, Proteins and Anthropometry Nutritional Screening, Sarcopenia and Body Composition on the Clinical Evolution of Hospitalized Patients. Nutrients 2023; 16:14. [PMID: 38201844 PMCID: PMC10780303 DOI: 10.3390/nu16010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: Hospital malnutrition and sarcopenia are common in inpatients and are associated with worse prognosis. Our objective is to determine the association of the positivity of CIPA (Control of Intakes, Proteins and Anthropometry) nutrition screening tool and sarcopenia and evaluate its prognostic implications (length of stay, readmissions and mortality) as well as different components of body composition. (2) Methodology: Cross-sectional single-center study and prospective six months follow-up for prognostic variables. On admission, CIPA and EWGSOP2 criteria were assessed. (3) Results: Four hundred inpatients, a median of 65.71 years old and 83.6% with high comorbidity, were evaluated. In total, 34.8% had positive CIPA and 19.3% sarcopenia. Positive CIPA and sarcopenia had worse results in body composition (fat mass (FM), fat-free mass (FFM) and appendicular skeletal muscle mass index (ASMI)) and dynamometry. Positive CIPA is significantly associated with worse prognosis (mortality (OR = 1.99), readmissions (OR = 1.86) and length of stay (B = 0.19)). Positive CIPA and sarcopenia combined are associated with a tendency to higher mortality (OR = 2.1, p = 0.088). Low hand grip strength (HGS) is significantly related to a higher length of stay (B = -0.12). (4) Conclusions: In hospitalized patients, malnutrition independently and combined with sarcopenia is associated with a worse prognosis but not body composition. Low HGS is related to a higher length of stay.
Collapse
Affiliation(s)
- Elena Márquez Mesa
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Ctra. Del Rosario 145, 38010 Santa Cruz de Tenerife, Spain; (J.P.S.L.)
| | - José Pablo Suárez Llanos
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Ctra. Del Rosario 145, 38010 Santa Cruz de Tenerife, Spain; (J.P.S.L.)
| | | | - Carla Brito Negrín
- Faculty of Health Sciences, University of La Laguna, Calle Padre Herrera, 38200 La Laguna, Spain
| | - María García Ascanio
- Faculty of Health Sciences, University of La Laguna, Calle Padre Herrera, 38200 La Laguna, Spain
| | - Samuel González González
- Faculty of Health Sciences, University of La Laguna, Calle Padre Herrera, 38200 La Laguna, Spain
| | - Ignacio Llorente Gómez de Segura
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Ctra. Del Rosario 145, 38010 Santa Cruz de Tenerife, Spain; (J.P.S.L.)
| |
Collapse
|
2
|
BALDEMİR R, ERASLAN DOĞANAY G, CIRIK MÖ, ÜLGER G, YURTSEVEN G, ZENGİN M. The relationship between acute physiology and chronic health evaluation-II, sequential organ failure assessment, Charlson comorbidity index and nutritional scores and length of intensive care unit stay of patients hospitalized in the intensive care unit due to chronic obstructive pulmonary disease. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1147178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: It is known that disease severity and nutritional status are determinants of prognosis in patients hospitalized in the intensive care unit (ICU). Different scoring systems are used to evaluate the nutritional status and disease severity of intensive care patients. It will be very useful in clinical practice to determine the intensive care scores that are in harmony with the nutritional parameters and affect the length of stay in the ICU in patients hospitalized with the diagnosis of chronic obstructive pulmonary disease (COPD). It was aimed to determine the relationship between acute physiology and chronic health evaluation-II (Apache-II), sequential organ failure assessment (SOFA), and Charlson comorbidity index (CCI) with nutritional scores in intensive care patients with a diagnosis of COPD. Also, it was aimed to determine the scoring systems that affect the length of stay in the ICU.
Material and Method: Nutritional risk score-2002 (NRS-2002), prognostic nutritional index (PNI), modified nutritional risk in critically ill (mNutric) score, albumin, Apache-II, SOFA and CCI values and intensive care unit length of stay of the patients hospitalized in the intensive care unit due to COPD were recorded. The scoring systems that affect the length of stay in the ICU and the relationship between nutritional scores and Apache-II, SOFA and CCI was analyzed using statistical methods.
Results: A significant correlation was found between only CCI and all nutritional scores. Only the CCI value was found to be significantly higher in those found to be at high risk compared to all nutritional scoring systems. CCI cut-off value determined according to nutritional scoring was determined as 4.5 according to PNI and albumin, and 5.5 according to mNutric score and NRS-2002. It was determined that CCI affects the length of stay in the intensive care unit.
Conclusion: CCI is a scoring system that is compatible with nutritional parameters and affects the length of stay in the intensive care unit. Therefore, we think that CCI can be used to predict prognosis and nutritional risk in patients with COPD in the intensive care unit and to predict the length of stay in the intensive care unit. In terms of malnutrition risk, a cut-off value of ≥6 can be used for CCI.
Collapse
Affiliation(s)
| | | | | | - Gülay ÜLGER
- Ankara Atatürk Sanatoryum Eğitim ve Araştırma Hastanesi
| | | | - Musa ZENGİN
- Ankara Atatürk Sanatoryum Eğitim ve Araştırma Hastanesi
| |
Collapse
|
3
|
GÜZEL S, KESER A, KEPENEKCİ BAYRAM İ. Risk of malnutrition in general surgical patients. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.823458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|
4
|
Santos CAD, Rosa CDOB, Franceschini SDCC, Firmino HH, Ribeiro AQ. Nutrition Risk Assessed by STRONGkids Predicts Longer Hospital Stay in a Pediatric Cohort: A Survival Analysis. Nutr Clin Pract 2020; 36:233-240. [PMID: 33175423 DOI: 10.1002/ncp.10589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/20/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND We evaluated the impact of Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) classification in time to discharge and verify whether the nutrition risk assessed by this method is an independent predictor of hospital length of stay (LOS) in pediatric inpatients. METHODS A cohort study was conducted in a Brazilian hospital from February 2014 to July 2018. The outcome in the survivor analysis was hospital discharge. Kaplan-Meier curves were used to estimate the cumulative survival time according to STRONGkids categories. Multivariable Cox proportional hazard models were fitted, and the adjusted hazard ratio (aHR), with respective 95% CI, was used to measure the strength of association. The discriminatory ability of STRONGkids was verified by a receiver operating characteristic curve RESULTS: A total 641 patients were included in the study: 54.9% males, median age of 2.8 years. The frequencies of low, moderate, and high nutrition risk were 15.6%, 63.7%, and 20.7%, respectively. The mean LOS was 5.9 days. Survival curves differed significantly according to nutrition-risk categories. Patients classified as high risk had a 52% less chance of hospital discharge when compared with low-risk patients (aHR: 0.48; 95% CI, 0.35-0.65). STRONGkids score ≥ 3 showed the best discriminatory power to identify LOS. From this score, there was a significant increase in the days of hospitalization. CONCLUSION The nutrition risk assessed by STRONGkids independently predicts LOS in pediatric patients. For this outcome, patients with 3 points (moderate risk) should be treated with the same priority as those with high risk.
Collapse
Affiliation(s)
| | | | | | - Heloísa Helena Firmino
- Multidisciplinary Nutritional Therapy Team, São Sebastião Hospital, Viçosa, Minas Gerais, Brazil
| | - Andréia Queiroz Ribeiro
- Department of Nutrition and Health, Federal University of Viçosa, Viçosa, Minas Gerais, Brazil
| |
Collapse
|
5
|
Altered Preoperative Nutritional Status in Colorectal Cancer: A Not So Infrequent Issue. J Nutr Metab 2020; 2020:5049194. [PMID: 34221498 PMCID: PMC8225445 DOI: 10.1155/2020/5049194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 10/22/2020] [Accepted: 10/24/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Malnutrition and weight loss in cancer patients is a common problem that affects the prognosis of the disease. In the case of CRC, malnutrition rates range between 30 and 60%. Objectives Description of the preoperative nutritional status of patients diagnosed with colorectal neoplasia who will undergo surgery. Materials and Methods A prospective observational study is performed. Results Of 234 patients studied, we observed that 139 (59%) had some degree of nutritional risk. Of all of them, 44.9% (N = 47) had 1-2 points according to MUST and 25% (N = 27) had more than 2 points. No differences were found when studying nutritional risk according to the location of the neoplasm. It was observed that 2.15% of the patients were underweight, 51% overweight, and 23% obese. 19.4% of patients lost less than 5 kg in the 3–6 months prior to diagnosis, 20.7% lost between 5 and 10 kg, and 2.1% lost more than 10 kg. In asymptomatic patients, the weight loss was lower than in symptomatic patients, loss <5 kg, 8.2% vs. 22.8%, and loss 5–10 kg, 16.2% vs. 29.3%, with a value of p = 0.016. 5% (N = 7) of the patients had hypoalbuminemia record. 16.5% (N = 23) had some degree of prealbumin deficiency and 20.9% (N = 29) of hypoproteinemia. Symptomatic patients had more frequent analytical alterations, 1-2 altered parameters in 48.8% (N = 20) of asymptomatic vs. 61.2% (N = 22) in the symptomatic, p = 0.049.
Collapse
|
6
|
Validation of CIPA nutritional screening through prognostic clinical variables in hospitalized surgical patients. ACTA ACUST UNITED AC 2019; 67:304-309. [PMID: 31668927 DOI: 10.1016/j.endinu.2019.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/03/2019] [Accepted: 07/10/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION CIPA (Control of Food Intake, Protein, and Anthropometry) nutritional screening is positive when one of the following conditions is met: Control of Food Intake for 48-72h <50%; Albumin <3g/dL, Body Mass Index <18.5kg/m2 or Arm Circumference ≤22.5cm. Following its validation in non-surgical inpatients, the same process was performed with surgical inpatients. OBJECTIVES Validity of the CIPA screening tool in surgical inpatients by comparison with Subjective Global Assessment (SGA) and analysis of clinical outcomes. MATERIAL AND METHODS A prospective study of hospitalized surgical patients, evaluating the prevalence or risk of malnutrition through CIPA and SGA. Analysis of hospital malnutrition according to CIPA screening and association with the clinical outcomes of median length of stay, mortality and early readmission. Concordance between both screening methods by Kappa Index (κ), sensitivity (S) and specificity (SP). RESULTS A total of 226 patients were analysed. The prevalence of malnutrition or risk of malnutrition was identified by CIPA in 35.40% and by SGA in 30.08%. CIPA is capable of detecting patients at a greater risk of mortality during hospitalization (5% vs. 0%, P=.006), unlike the SGA (2.94% vs. 1.27%, P=.385). CIPA also detected patients with higher median length of stay (21 days [IQR 14-34 days] vs. 14.5 days [IQR 9-27 days], P=.002) and rate of early readmissions (25.3% vs. 8.2%, P<.001). S and SP of CIPA vs. SGA was 70.59% and 79.75%, respectively; Kappa index was 0.479 (P<.001). CONCLUSIONS Using CIPA nutritional screening, the prevalence and risk of malnutrition in surgical patients is high, and they present poorer clinical outcomes, making CIPA valid and effective in this type of patients.
Collapse
|
7
|
Stollhof LE, Braun JM, Ihle C, Schreiner AJ, Kufeldt J, Adolph M, Wintermeyer E, Stöckle U, Nüssler A. The continuous downgrading of malnutrition in the German DRG system: possible effects on the treatment of patients at risk for malnutrition. EXCLI JOURNAL 2019; 18:370-381. [PMID: 31338008 PMCID: PMC6635725 DOI: 10.17179/excli2019-1256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/24/2019] [Indexed: 11/25/2022]
Abstract
It has been internationally recognized that malnutrition is an independent risk factor for patients' clinical outcome. A new mandatory fixed price payment system based on diagnosis-related groups (G-DRG) went into effect in 2004. The aim of our study was to demonstrate the importance of carefully coding the secondary diagnosis of "malnutrition" in the G-DRG system and to highlight how the economic relevance of malnutrition in the G-DRG system has changed from 2014 to 2016. 1372 inpatients at the Berufsgenossenschaftliche Unfallklinik (Trauma Center) in Tübingen were screened for the risk of malnutrition using Nutritional Risk Screening (NRS-2002). Patient data were compared with the NRS values collected during the study and a case simulation was carried out separately for each year. We used the codes E44.0 for NRS = 3 and E43.0 for NRS > 3. The ICD codes were entered as an additional secondary diagnosis in the internal hospital accounting system DIACOS to determine possible changes in the effective weight. In 2014 the highest additional revenue by far was calculated by coding malnutrition. For the 638 patients enrolled in the study in 2014, we were able to calculate an average additional revenue per patient coded with malnourishment of €107. In 2016, we were unable to calculate any additional revenue for the 149 patients enrolled. Although it is well known that malnutrition is an independent risk factor for poor patient outcomes, nationwide screening for a risk of malnutrition when patients are admitted to a hospital is still not required. For this reason, malnutrition in German hospitals continues to be insufficiently documented. Due to the continuous downgrading of diagnosis-related severity (CCL) of malnutrition in the G-DRG system in trauma surgery patients, it is no longer possible to refinance the costs incurred by malnourished patients through the conscientious coding of malnutrition. We assume that the indirect positive effects of nutritional interventions will have to be taken into account more in the costing calculations and possibly lead to indirect cost compensation.
Collapse
Affiliation(s)
- Laura E Stollhof
- Department of Traumatology, BG Unfallklinik Tübingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen
| | - Jessica M Braun
- Department of Traumatology, BG Unfallklinik Tübingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen
| | - Christoph Ihle
- Department of Traumatology, BG Unfallklinik Tübingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen
| | - Anna J Schreiner
- Department of Traumatology, BG Unfallklinik Tübingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen
| | - Johannes Kufeldt
- Department of Traumatology, BG Unfallklinik Tübingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen
| | - Michael Adolph
- Department of Traumatology, BG Unfallklinik Tübingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen
| | - Elke Wintermeyer
- Department of Traumatology, BG Unfallklinik Tübingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen
| | - Ulrich Stöckle
- Department of Traumatology, BG Unfallklinik Tübingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen
| | - Andreas Nüssler
- Department of Traumatology, BG Unfallklinik Tübingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen
| |
Collapse
|
8
|
Yárnoz‐Esquíroz P, Lacasa C, Riestra M, Silva C, Frühbeck G. Clinical and financial implications of hospital malnutrition in Spain. EUROPEAN EATING DISORDERS REVIEW 2019; 27:581-602. [DOI: 10.1002/erv.2697] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 02/08/2019] [Accepted: 06/12/2019] [Indexed: 12/12/2022]
Affiliation(s)
| | - Carlos Lacasa
- Pharmacy ServicesClínica Universidad de Navarra Pamplona Spain
| | - María Riestra
- Diets ServicesClínica Universidad de Navarra Pamplona Spain
| | - Camilo Silva
- Department of Endocrinology and NutritionClínica Universidad de Navarra, CIBEROBN, IdiSNA Pamplona Spain
| | - Gema Frühbeck
- Department of Endocrinology and NutritionClínica Universidad de Navarra, CIBEROBN, IdiSNA Pamplona Spain
| |
Collapse
|
9
|
Suárez-Llanos JP, Rosat-Rodrigo A, García-Niebla J, Vallejo-Torres L, Delgado-Brito I, García-Bello MA, Pereyra-García-Castro F, Barrera-Gómez MA. Comparison of Clinical Outcomes in Surgical Patients Subjected to CIPA Nutrition Screening and Treatment versus Standard Care. Nutrients 2019; 11:E889. [PMID: 31010007 PMCID: PMC6520912 DOI: 10.3390/nu11040889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/13/2019] [Accepted: 04/17/2019] [Indexed: 12/20/2022] Open
Abstract
Malnutrition is prevalent in surgical patients and leads to comorbidities and a poorer postoperative course. There are no studies that compare the clinical outcomes of implementing a nutrition screening tool in surgical patients with standard clinical practice. An open, non-randomized, controlled study was conducted in general and digestive surgical hospitalized patients, who were either assigned to standard clinical care or to nutrition screening using the Control of Food Intake, Protein, and Anthropometry (CIPA) tool and an associated treatment protocol (n = 210 and 202, respectively). Length of stay, mortality, readmissions, in-hospital complications, transfers to critical care units, and reinterventions were evaluated. Patients in the CIPA group had a higher Charlson index on admission and underwent more oncological and hepatobiliary-pancreatic surgeries. Although not significant, a shorter mean length of stay was observed in the CIPA group (-1.48 days; p < 0.246). There were also fewer cases of exitus (seven vs. one) and fewer transfers to critical care units in this group (p = 0.068 for both). No differences were detected in other clinical variables. In conclusion, patients subjected to CIPA nutrition screening and treatment showed better clinical outcomes than those receiving usual clinical care. The results were not statistically significant, possibly due to the heterogeneity across patient groups.
Collapse
Affiliation(s)
- José Pablo Suárez-Llanos
- Endocrinology and Nutrition Department, University Hospital Nuestra Señora de Candelaria (HUNSC), 38010 Santa Cruz de Tenerife, Spain.
| | - Adriá Rosat-Rodrigo
- General and Digestive Surgery Department, HUNSC, 38010 Santa Cruz de Tenerife, Spain.
| | | | - Laura Vallejo-Torres
- Department of Quantitative Methods in Economics and Management, University of Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain.
- Canary Islands Foundation for Health Research (FUNCANIS), 38109 Santa Cruz de Tenerife, Spain.
- Health Services Research on Chronic Patients Network (REDISSEC), 38010 Santa Cruz de Tenerife, Spain.
| | - Irina Delgado-Brito
- Canary Islands Cancer Research Institute (FICIC), 38204 Santa Cruz de Tenerife, Spain.
| | - Miguel A García-Bello
- Department of Clinical Epidemiology and Biostatistics, HUNSC; Primary Care Management, 38010 Santa Cruz de Tenerife, Spain.
| | - Francisca Pereyra-García-Castro
- Endocrinology and Nutrition Department, University Hospital Nuestra Señora de Candelaria (HUNSC), 38010 Santa Cruz de Tenerife, Spain.
| | | |
Collapse
|
10
|
Suárez-Llanos JP, Vallejo-Torres L, García-Bello MÁ, Hernández-Carballo C, Calderón-Ledezma EM, Rosat-Rodrigo A, Delgado-Brito I, Pereyra-García-Castro F, Benitez-Brito N, Felipe-Pérez N, Ramallo-Fariña Y, Romero-Pérez JC. Cost-effectiveness of the hospital nutrition screening tool CIPA. Arch Med Sci 2019; 16:273-281. [PMID: 32190136 PMCID: PMC7069439 DOI: 10.5114/aoms.2018.81128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 11/25/2018] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Hospital malnutrition is very common and worsens the clinical course of patients while increasing costs. Lacking clinical-economic studies on the implementation of nutrition screening encouraged the evaluation of the CIPA (Control of Food Intake, Protein, Anthropometry) tool. MATERIAL AND METHODS An open, non-randomized, controlled clinical trial was conducted on patients admitted to internal medicine and general and digestive surgery wards, who were either assigned to a control (standard hospital clinical care) or to an intervention, CIPA-performing ward (412 and 411, respectively; n = 823). Length of stay, mortality, readmission, in-hospital complications, and quality of life were evaluated. Cost-effectiveness was analysed in terms of cost per quality-adjusted life years (QALYs). RESULTS The mean length of stay was higher in the CIPA group, though not significantly (+ 0.95 days; p = 0.230). On the surgical ward, more patients from the control group moved to critical care units (p = 0.014); the other clinical variables did not vary. Quality of life at discharge was similar (p = 0.53), although slightly higher in the CIPA group at 3 months (p = 0.089). Patients under CIPA screening had a higher mean cost of € 691.6 and a mean QALY gain over a 3-month period of 0.0042. While the cost per QALY for the internal medicine patients was € 642 282, the results for surgical patients suggest that the screening tool is both less costly and more effective. CONCLUSIONS The CIPA nutrition screening tool is likely to be cost-effective in surgical but not in internal medicine patients.
Collapse
Affiliation(s)
- José Pablo Suárez-Llanos
- Endocrinology and Nutrition Department, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Laura Vallejo-Torres
- Department of Quantitative Methods in Economics and Management, University of Las Palmas de Gran Canaria, Spain
- Canary Islands Foundation for Health Research (FUNCANIS), Health Services Research on Chronic Patients Network (REDISSEC)
| | - Miguel Ángel García-Bello
- Division of Clinical Epidemiology and Biostatistics, Research Unit, HUNSC, Primary Care Management, Santa Cruz de Tenerife, Spain
| | - Carolina Hernández-Carballo
- Internal Medicine Department, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Adriá Rosat-Rodrigo
- General and Digestive Surgery Department, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Irina Delgado-Brito
- Fundación Instituto Canario de Investigación del Cáncer, Santa Cruz de Tenerife, Spain
| | | | - Nestor Benitez-Brito
- Fundación Instituto Canario de Investigación del Cáncer, Santa Cruz de Tenerife, Spain
| | - Nieves Felipe-Pérez
- Internal Medicine Department, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Yolanda Ramallo-Fariña
- Canary Islands Foundation for Health Research (FUNCANIS), Health Services Research on Chronic Patients Network (REDISSEC)
| | - Juan Carlos Romero-Pérez
- Internal Medicine Department, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| |
Collapse
|